- CMT Still Does Not Cause Cervical Artery Dissection.ICCN Clinical Report From: European Spine Journal Take Home Message– Medical physicians often blame cervical arterial dissections (CeAD) on chiropractors using SMT – Research since Cassidy’s article in 2009 has continued to show that SMT is not causing CeAD– Dr. Whedon et al evaluated 40M patients each year for 9 years and found 2337 vertebral artery dissections (VAD) and 2916 carotid artery dissections (CAD), proving again the rare nature of these events. This is the … Read more
- Elite Soccer Players at Risk for DementiaICCN Clinical Report From: British Medical Journal Take Home Message:– An observational study of elite players in Sweden playing from 1924-2019– Elite soccer players may be susceptible to Alzheimer’s Disease and other dementias – They were found to have a lower risk of Motor neuron disease (Parkinson’s) Partial Article Elite male footballers (soccer) were 1.5 times as likely todevelop neurodegenerative disease as populationcontrols, found a study of men who played inSweden’s top division from 1924 … Read more
- Member SpotlightDr. Lucy Whyte Ferguson, a pain management diplomate, will miss our conference, unfortunately. She will be tied up presenting in Padua, Italy. (OMG! Wow!) She will be presenting the results of hr NIH sponsored research on myofascial and articular care of Adolescent Idiopathic Scoliosis. Also, she and other authors from The University of New Mexico, are submitting an article for publication in The Spine Journal within the next 2 months. I asked her to give … Read more
- Vitamin D supplementation May Reduce DementiaICCN Clinical Report From: Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring Journal TAKE-HOME MESSAGE Abstract Introduction Despite the association of vitamin D deficiency with incident dementia, the role of supplementation is unclear. We prospectively explored associations between vitamin D supplementation and incident dementia in 12,388 dementia-free persons from the National Alzheimer’s Coordinating Center. Methods Baseline exposure to vitamin D was considered D+; no exposure prior to dementia onset was considered D−. Kaplan–Meier curves compared … Read more
- Protopathic Bias and the “Chiropractic Stroke”ICCN Clinical Report Published in Dynamic Chiropractic Dr. Richard Cole, president of the ICCN, has written an article on the above matter. The article is available from Dynamic Chiropractic in their January issue. TAKE-HOME MESSAGE The full article is available here: https://www.dynamicchiropractic.com/digital/index.php?i=1296&a_id=59227&pn=53&r=t&Page=53
- Member SpotlightDr. David Taylor is a board member of the ICCN and is a clinical professor at Texas Chiropractic college. He has expertise in neurology, but has also studied, lectured and written on concussion and laser therapy (Photobiomodulatoin). He was recently published in the Journal of Chiropractic Education on chiropractic intern adherence to x-ray guidelines. Here is his recent article for your review. https://meridian.allenpress.com/jce/article/doi/10.7899/JCE-21-47/490380/An-investigation-into-chiropractic-intern?searchresult=1 Active in his community, David serves on the board of directors of … Read more
- Increasing Daily Fiber Intake May Decrease Severe Headache or Migraine.Published in Fronters in Nutrition ICCN Clinical Report TAKE-HOME MESSAGE Abstract Background: The data on the effect of dietary fiber on severe headaches or migraine are limited. Therefore, this study aimed to investigate the association between dietary fiber intake and the prevalence of severe headaches or migraine. Methods: We conducted a cross-sectional study involving 12,710 participants, all data collected from NHANES 1999–2004. A multivariable logistic regression model was used to analyze the relationship between dietary fiber intake … Read more
- Depressive Symptoms in Individuals with Persistent Post-concussion SymptomsPublished in Neurology TAKE-HOME MESSAGE Analysis of 18 studies involving 9101 individuals explored the association between persistent post-concussion symptoms (PPCS) and lingering depression. Participants with PPCS had a 4.56-times increased risk for experiencing symptoms of depression (P < .001). Chiropractic neurologists and pain management specialists should be aware of lingering depression in the post concussive patient and should assist patients in receiving understanding and support for lingering symptoms. Abstract Open article is fully available here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799945
- ICCN at NeuroCon 2022I am pleased to announce that we had a wonderful time at NeuroCon 2022 at Parker University a few weeks ago. President of Parker University, Dr. Bill Morgan, invited ICCNB Members to be his special guests at NeuroCon 2022 and about ten of us were able to make arrangements to attend. The ICCN Board approved us putting a booth at NeuroCon to announce ICCN so we could start making friends. Dr. Bill Morgan is a … Read more
- Muscle and Mitochondrial Changes in Long CovidICCN Clinical Report From: European Journal of Neurology TAKE-HOME MESSAGE This study assessed the histopathological changes in 16 patients with post–COVID-19 fatigue. Muscle weakness was noted in 8 patients and myopathic changes in EMG were noted in 12 patients. Histological changes were noted in all patients. Mitochondrial changes such as loss of cytochrome c oxidase activity, subsarcolemmal accumulation, and abnormal cristae were observed in 62% of the patients. Signs of inflammation were noted in 62%. … Read more
- Pain and Swelling Prevention following Knee ArthroplastyICCN Clinical Report From: The Knee TAKE-HOME MESSAGE Chiropractors regularly refer their patients to orthopedics for knee arthroplasty Knee arthroplasty usually results in pain and swelling which can limit function, cause DVT and is uncomfortable for patients. In this study, a chiropractor working on his PHD thesis studied a novel system of home therapy that has proven to control swelling and pain. The use of a compression garment, lymphatic massage and home exercises were added … Read more
- Parkinson’s Patients Do Better with FlavonoidsICCN Research Update From: Neurology TAKE-HOME MESSAGE Parkinson’s patients struggle dealing with their disease. This article demonstrates that higher dietary flavonoid intake by Parkinson’s patients improves their life expectancy Patients with diets rich in flavonoids prior to Parkinson’s diagnosis also faired much better than those who did not enjoy flavonoids. Greater consumption of total flavonoid phytonutrients (chocolate, apples, tea, berries, red wine) were associated with lower mortality risks. Research states that you need at least … Read more
- Open Letter of InvitationDear Colleague, I am honored to welcome you to the 1st International Conference on Advances in Migraine Sciences (ICAMS), which will be held in Copenhagen, March 10-12, 2022. More than 1,100 people have already registered for ICAMS. The scientific programme consists of state-of-the-art lectures, debates, and poster presentations on issues of interest for the migraine field. ICAMS 2022 is a hybrid event that provides the possibility of online participation for international attendees; thus, aiming to meet the needs … Read more
- CBD Oil Blocks Sars-CoV-2 InfectionICCN Clinical Report From: Journal of Natural Products 2022 TAKE-HOME MESSAGE Naturally occurring products frequently form the basis of drug therapies that are available today. In this study, CBD oil was found to block the capacity for Sars-CoV-2 to enter human cells, providing a mechanism for prevention and therapeusis To identify small molecule therapeutic agents, affinity selection-mass spectrometry was used to discover botanical ligands to Sars-CoV-2 spike protein Cannabigerolic acid (CBGA) and cannabidiolic acid (CBDA) … Read more
- MRI Findings of Brain Volume Micro Changes in Sars-CoV-2ICCN Clinical Report – From: E Clinical Medicine – A division of The Lancet TAKE-HOME MESSAGE Covid 19 infection is documented to cause significant brain changes, initially with loss of grey matter followed by neurogenesis and increased grey matter volume with recovery. Recovered patients showed significantly enlarged volumes in the bilateral olfactory cortices, hippocampi, insulas, left Heschl’s gyrus, left Rolandic operculum and right cingulate gyrus. All these structures relate to the central olfactory system. The … Read more
- Primary Spine Care Beats Primary Medical Care for Spine Related PainPublished in: Chiropractic and Manual Therapies TAKE-HOME MESSAGE Chiropractors and chiropractic patients experience the cost/benefit analysis of early chiropractic intervention on spine related complaints. This study compares two models of spine care… Primary spine care (PSC = chiropractic care) and primary medical care (PMC = medication) for spine related complaints. Results show that there is a significant benefit in early primary spine care intervention with greater resolution of the complaint, less use of advanced … Read more
- Chiropractic Care Improves Acute Neck PainICCN Research Review – Journal of Clinical Medicine Take Home Message: Chiropractors routinely use spinal manipulation as a modality of treatment for neck pain. General medical practitioners often fail to refer neck pain patients for chiropractic care due to lack of understanding about the effectiveness of chiropractic care for neck pain along with the fear of therapeutic side effects. NSAIDs are frequently used to manage neck pain. Adverse Drug Events (ADE) are a common complication … Read more
- Medicare Patients Healthier with Chiropractic CareICCN Research Review Take Home Message: Chiropractors routinely use spinal manipulation as a modality of treatment for spine pain. In this review, the authors show that patients have a reduced risk of medication side effects when spinal manipulation is used as an early form of treatment. NSAIDs are frequently used to manage musculoskeletal pain. Adverse Drug Events (ADE) are a common complication with NSAIDs and many other drugs. Patients who do not choose chiropractic care … Read more
- Spinal Manipulation May Help Stroke PatientsPublished: Brain Sciences (open access) Take Home Message Stroke patients may face a severe decline in quality of life Neuroplasticity allows for stroke recovery Spinal manipulation shows promise as a mechanism to improve the function of stroke patients. Patients studied improved in areas of pain perception, memory and navigation. Abstract Stroke impairments often present as cognitive and motor deficits, leading to a decline in quality of life. Recovery strategy and mechanisms, such as neuroplasticity, are important … Read more
- Dr. Taylor PublishedIt has come to our attention that Dr. David Taylor, ICCN Board Secretary, has been busy writing and publishing peer reviewed articles. He has recently published three works. Best Practices for Chiropractic Management of Patients with Chronic Musculoskeletal Pain: A Clinical Practice Guideline was published in the Journal of Complimentary and Alternative Medicine. It is a very well thought out work supporting our services in the treatment of acute and chronic LBP, headache, hip osteoarthritis … Read more
- Dr. Boesch Published in History of Chiropractic JournalDr. Ron Boesch (Neurology and Pain Management) was published this month in the Journal of Chiropractic History. His paper was on the efforts the International Chiropractic Association (ICA) used to increase athletes access to chiropractic. The ICA had developed a commission to spearhead professional and amateur athlete awareness and benefits of chiropractic. This months Journal contents can be reviewed here. https://www.historyofchiropractic.org/the-journal/current-issue/ Interested parties can also get access to the article through this Association of Chiropractic … Read more
- ICCN Website UpdateThe ICCN tech team has finalized the new website. The site should look the same but there are robust changes were “under the hood”. You should get noticed when new postings are up and now you can log in to read the postings. The site is more stable and updated for improved function. We have a lot of research posted on our site that is relevant to neurology and the pain patient. Take a look and … Read more
- SPECIFIC EXERCISES REDUCE CHRONIC LBPPublished in Neurology TAKE HOME MESSAGE Specific Muscular Training (SMT) was superior to basic core stability and flexibility training in managing LBP SMT consisted of training activities that limited lumbar spine end range of motion while increasing hip hinge capacity. SMT was designed to improve proper lumbar spine movement when involved in daily activities Patients with chronic LBP may benefit better from exercises designed to teach proper movement patterns instead of focusing on flexibility or … Read more
- History of Covid-19 Infection Protects from Re-infection.Published in Lancet TAKE-HOME MESSAGE Chiropractic neurologists and chiropractic pain physicians must remain up to date on health crises as they present in the culture There was an open question regarding the immunity gained via direct covid-19 infection and the length of time the immunity was effective This study shows that patients with a history of Covid-19 infection had an 84% lower risk of reinfection. The study had 2500 participants followed for 12 months. Protection … Read more
- Capsaicin – Potential Solution for Chronic Pain TreatmentAbstract: Chronic pain is a painful condition defined by its duration where pain persists three months or more. Pain is connected with the high price of health care, work inability and disability. Moreover, it has significant consequences for patients and their families, working organizations and the society as a whole. The prevalence of chronic pain can range between 11.0% and 51.3% in general population. Pain is usually coherent with distress and a range of psychological … Read more
- Headache in Patients With Covid-19 InfectionPublished in Headache TAKE-HOME MESSAGE Chiropractic physicians board certified in neurology and pain management often manage patients with headache, are essential healthcare workers and are engaged in the fight against Covid-19 and co-morbid presentations. The authors summarize current literature regarding headache and Covid-19 and note that headache is a common complaint of patients presenting with acute COVID-19 infection. Covid-19 headaches present as a pressure sensation. For symptomatic management, the authors recommend typical treatments with … Read more
- Migraine as a Cortical Brain DisorderTAKE-HOME MESSAGE Migraine has been a difficult condition to fully understand Advanced neuroimaging data and neurophysiological research indicate that fluctuating excitability, plasticity, and metabolism of cortical neurons represent the pathophysiological substrate of the migraine cycle. Migraine disorder stems, in part, from an imbalance in inhibitory/excitatory cortical circuits Spinal Manipulative Therapy (SMT) has been found to have an effect on the pre-frontal cortex and this may explain why some migraine patients improve with SMT. Physicians with … Read more
- The role of structure and function changes of sensory nervous system in intervertebral disc-related low back painSummary:Low back pain (LBP) is a common musculoskeletal symptom, which can be developed in multiple clinical diseases. It is widely recognized that intervertebral disc (IVD) degeneration (IVDD) is one of the leading causes of LBP. However, the pathogenesis of IVD-related LBP is still controversial, and the treatment means are also insufficient to date. In recent decades, the role of structure and function changes of sensory nervous system in the induction and the maintenance of LBP … Read more
- Melatonin for Acute Treatment of Migraine in Children and Adolescents: A Pilot Randomized TrialAbstract ObjectiveTo determine what dose of melatonin is most effective for treating migraine acutely in children and adolescents. BackgroundAcute migraine medications may not work for all patients and may cause side effects. Melatonin is effective for migraine prevention in adults and has been used acutely for procedural pain in children. Our goal was to determine whether a “high” or “low” dose of melatonin is more effective for treating migraine acutely in youth. MethodsIn this pilot, … Read more
- Neurological Complications Associated with the Blood-Brain Barrier Damage Induced by the Inflammatory Response During SARS-CoV-2 InfectionAbstract The main discussion above of the novel pathogenic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has focused substantially on the immediate risks and impact on the respiratory system; however, the effects induced to the central nervous system are currently unknown. Some authors have suggested that SARS-CoV-2 infection can dramatically affect brain function and exacerbate neurodegenerative diseases in patients, but the mechanisms have not been entirely described. In this review, we gather information from … Read more
- Associations of Psychologic Factors with Multiple Chronic Overlapping Pain ConditionsAims: To characterize psychologic functioning across five chronic overlapping pain conditions (COPCs)-temporomandibular disorders, fibromyalgia, low back pain, headache, and irritable bowel syndrome-and their overlaps. Methods: Participants were 655 adults in the OPPERA study. Psychologic variables were standardized in separate logistic regression models to compare their relative strength of association with each COPC. Random forest regression was used to explore the association of all psychologic measures with COPCs simultaneously. Linear regression analyses examined whether the count … Read more
- Dietary Vitamin E Intake Was Inversely Associated with Hyperuricemia in US Adults: NHANES 2009–2014 — Implications for gout management?Introduction: Current evidence on the association between dietary vitamin E intake and hyperuricemia risk is limited and conflicting. Objective: The aim of the study was to assess the association of dietary vitamin E intake with hyperuricemia in US adults. Methods: We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey, 2009–2014. Dietary vitamin E intake was evaluated through two 24-h dietary recall interviews. Logistic regression and restricted cubic spline models … Read more
- The Cost-Effectiveness of Platelet-Rich Plasma Compared With Hyaluronic Acid Injections for the Treatment of Knee OsteoarthritisAlthough a series of either PRP ($8,635.23/QALY) or HA ($5,331.75/QALY) injections for the treatment of symptomatic knee osteoarthritis would be considered cost-effective (cost per QALY < $50,000), PRP injections were not more cost-effective than HA injections. However, PRP was significantly more effective at 1 year, and being associated with an incremental cost-effectiveness ratio of $12,628.15/QALY when compared with HA, a series of PRP injections should be considered a reasonable and acceptable alternative to HA injections … Read more
- Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, ChinaTake Home Message 36.4% of patients with Covid-19 exhibit neurological symptoms. Chiropractic neurologist should be vigilant when examining patients with headache, dizziness, impaired smell and taste, impaired vision, musculoskeletal pain and nerve pain. When examining patients even without fever, consider Covid-19 as a possible cause of the patients problem. Abstract Importance The outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, is serious and has the potential to become an epidemic worldwide. Several studies have described … Read more
- ICCN Supports AAPM DCsThe ICCN is now offering credentialing support for chiropractors board certified by the American Academy of Pain Management (AAPM) also known by its newer name the Academy of Integrative Pain Management (AIPM). The AAPM/AIPM went bankrupt in January 2019 leaving all members hanging. Some AAPM members had recently paid their fees and provided credentialing CE hours only to see it all evaporate. The bankruptcy of the AAPM was blamed on declining membership, loss of revenue … Read more
- Mediterranean Diet Is Associated With Lower Probability of Prodromal Parkinson’s DiseaseTAKE-HOME MESSAGE A Mediterranean diet seems to delay the onset of Parkinson’s disease (PD) in an elderly population. Researchers used the Movement Disorder Society (MDS) research criteria for prodromal Parkinson’s Disease along with measuring the dietary habits of a population in Greece. Eating a Mediterranean diet may result in delayed onset or lower incidence of PD. Abstract BACKGROUND The International Parkinson and Movement Disorder Society recently introduced a methodology for probability score calculation for prodromal … Read more
- Multiple joint pains associated with poor psychosocial health and increased medication use.Take Home Message Psychological status is compromised in patients suffering joint pains in multiple joints Medication use increases for patients suffering with pain in multiple joints Clinicians may improve psychological status of their patients by controlling the inflammatory response through deflaming the body. Abstract Background Musculoskeletal pain frequently occurs in more than one body region, with up to 80% of adults reporting more than one joint pain site in the last 12 months. Older people and … Read more
- Ultrasound Is a Reproducible Diagnostic Tool in Peripheral NeuropathyNerve Ultrasound: A Reproducible Diagnostic Tool in Peripheral Neuropathy TAKE-HOME MESSAGE Peripheral neuropathies are now being evaluated by the use of diagnostic ultrasound. Standard protocols were used by the authors of this prospective, multicenter study. The cross section of the median, ulnar, fibular, tibial, sural nerves, and brachial plexus were measured in patients with acquired chronic demyelinating or axonal polyneuropathy and in healthy controls. Systematic differences between measurements made by different investigators were small Nerve … Read more
- ICCN President Challenges UHC Policy on HeadacheDr. Richard Cole, President of the ICCN challenged United Healthcare’s new policy that prohibits reimbursement for spinal manipulation for the treatment of headache pain. The challenge was in the form of a letter that Dr. Cole sent today to Mr. Dan Schumacher, president and CEO of United Healthcare. “At a time when everyone is looking for alternative pain treatment to fight the opioid addiction, this is a really stupid move.” stated Dr. Cole. “This decision … Read more
- Manipulation Does Not Cause DissectionManipulation Does Not Cause Dissection TAKE-HOME MESSAGE Early case reports suggested that cervical manipulation (CM) was the cause of cervical artery dissection (CAD) in patients and their resultant cerebrovascular accidents. Cassidy published a 2008 report in Spine calling this assertion into question and found that the association of dissection following chiropractic physician exposure was similar to exposure to primary care physicians. Since that time, multiple papers have continued call into question whether CM was causative of CAD. Based … Read more
- Functional Neurology InvestigatedFunctional Neurology Investigated Take Home Message: Functional neurology (FN) is a novel approach of understanding, diagnosing and managing a wide variety of neurological and musculoskeletal complaints In this review, the authors describe the functional neurology approach to neurological disease using standard and unique neurological understanding and testing procedures. As with many novel techniques, FN has been highly criticized for a lack of scientific support, stating that the therapeutic approach is ahead of the scientific evidence … Read more
- Spontaneous Vertebral Artery DissectionSpontaneous Vertebral Artery Dissection Take Home Message: Vertebral artery dissection (VAD) has been associated with fast neck movements including cervical manipulation (CM) Recent research has called into question any role cervical manipulation may play with regard to causing VAD This article demonstrates a fully spontaneous VAD without exposure to cervical manipulation, sports trauma or fast neck movements. This article adds to the literature that calls into question any relationship between CM and VAD. Abstract The article represents a … Read more
- Dr. Taylor Published in JCMDr. Taylor Published in JCM Our own Dr. David Taylor was published in the March 2017 edition of JCM in a pilot study on concussion. It is fair to say that some of the best research being done in concussion is from the world of chiropractic medicine and we are thrilled to see Dr. Taylor as a part of the body of literature. Here is the abstract for you to review. https://www.ncbi.nlm.nih.gov/pubmed/28228694 David’s article can … Read more
- Underrecognized Sleep Disorders Persist Following mTBIUnderrecognized Sleep Disorders Persist Following mTBI TAKE-HOME MESSAGE Increased sleep needs are likely part of the recovery process after traumatic brain injury (TBI). However, there is increasing recognition that many patients have long-term sleep–wake disturbances as a residual consequence of TBI. In this comprehensive prospective study, patients with first-ever TBI were followed and a sleep assessment was performed 18 months after the trauma. Findings included: Sleep needs per 24 hours were persistently increased in TBI patients … Read more
- Surfer’s MyelopathyKey Points: Surfer’s myelopathy is a rare, acute, atraumatic myelopathy that occurs in novice surfers. Afflicted individuals are often thin, have poorly developed back musculature, but are otherwise healthy. Symptoms typically start with mild or intense back pain, rapidly progressing to complete or incomplete myelopathy. Clinical and imaging findings have suggested a vascular etiology leading to acute spinal infarction. T2 MRI characteristically exhibits increased signal intensity within the central portion of the spinal cord … Read more
- Dr. Ron Fudala Published in Dynamic ChiropracticDr. Ron Fudala Published in Dynamic Chiropractic ICCN Newswire: ICCN member Dr. Ron Fudala lectured on lumbar spinal stenosis at the Mid South Spine Symposium in Memphis, TN in February 2016. His lecture was stimulating and greatly appreciated by those in attendance. Since Dr. Fudala had done the research to prepare for his lectures, he decided to write up the info for publication in Dynamic Chiropractic (DC). DC is a trade journal with a distribution … Read more
- Even Mild Head Impact Impairs VisionEven Mild Head Impact Impairs Vision TAKE-HOME MESSAGE It is fully understood that concussion results in visual near point convergence (NPC) impairment. However, this article demonstrates that NPC is impaired even with multiple subconcussive head impacts. Though the authors believe NPC may become a tool in measuring and evaluating brain injury severity, it is my opinion that they have proven the opposite. Now we know that NPC is impaired following even subclinical and minor head bumps … Read more
- Melatonin Helps HeadachesMelatonin Helps Headaches TAKE-HOME MESSAGE Levels of the pineal hormone melatonin have been found to be low in migraine and in cluster headache. Melatonin acts as a biological clock for sleep, an antioxidant, an antihypertensive, an anxiolytic and a sedative. Oral melatonin has shown promising results in migraine prevention. This study demonstrated that 4mg of oral melatonin 30 minutes before bedtime demonstrated a significant reduction in tension type and migraine headaches. Chiropractic neurologists managing headaches … Read more
- Spinal Manipulation Changes Brain ProcessingSpinal Manipulation Changes Brain Processing TAKE-HOME Message For the past 15 years, researchers have observed changes in brain processing following spinal manipulation (SM). This article demonstrates that changes occur in the prefrontal cortex following cervical SM over areas of segmental dysfunction. The prefrontal cortex plays a vital role in sensory motor integration and higher executive function. This finding may answer why patients experience generalized pain improvement following SM and further supports the conclusion that SM … Read more
- Migraineurs Suffer Restless LegsMigraineurs Suffer Restless Legs TAKE-HOME MESSAGE Poor sleep is a confounder in migraine recovery and tends to increase migraine incidence. Restless leg syndrome (RLS) impairs high quality sleep. In this large study, migraine patients were found to have a higher prevalence of RLS than normal controls and their RLS symptoms were much worse. Efforts to control migraine that also address RLS may lead to better outcomes. Abstract BACKGROUND AND PURPOSE: Our aim was to study not … Read more
- Pediatric Migraine and StrokePediatric Migraine and Stroke TAKE-HOME MESSAGE Managing the pediatric headache is often complicated and understanding the risk factors faced by the pediatric patient is essential. This case demonstrates adolescent miganeurs seem to have an increase risk of ischemic stroke. However, that younger children with migraines do not share that risk profile. Abstract IMPORTANCE Our understanding of risk factors for childhood stroke is incomplete. In adults, migraine with aura is associated with a two-fold increase in … Read more
- Palpation Enhances Headache DiagnosisPalpation Enhances Headache Diagnosis TAKE-HOME MESSAGE Chiropractic physicians have historically relied heavily on palpation skills in their examination process. Medical physicians have been criticized for a reduction in use of manual examination and have begun to rely more solely on laboratory and radiographic examination. This article affirms that manual examination of the spine enhances the diagnostic accuracy of cervicogenic headache. Chiropractic physicians are well positioned to differentiate headache types due to their patient examination approach. Abstract … Read more
- Stomach Medicine Found to Cause DementiaStomach Medicine Found to Cause Dementia TAKE- HOME MESSAGE Proton pump inhibitors (PPIs) are commonly used to treat gastro-esophageal reflux disorders (GERD) and ulcers. A recent article published in JAMA Neurology has found that PPIs have been identified as being at risk for causing dementia. Chiropractic physicians may discuss this complication with their patients and advise patients who may be candidates for alternative treatment for GERD and ulcers. Abstract IMPORTANCE Medications that influence the risk … Read more
- Fitness Predicts Brain VolumeFitness Predicts Brain Volume TAKE-HOME MESSAGE Cognitive decline is a significant health problem plaguing millions of aging seniors. Prevention of cognitive decline is a goal of many and is attempted using diet and lifestyle modification This article provides proof that poor cardiovascular (CV) fitness is predictive of decreased brain volume two decades later in life. Neurologists should be encouraging midlife CV fitness as a prevention of brain aging. Abstract Objective: To determine whether poor cardiovascular (CV) … Read more
- Manipulation Better for Headache than MobilizationManipulation Better for Headache than Mobilization TAKE-HOME MESSAGE Headache is a significant health condition suffered by millions of people in the US costing billions of dollars in treatment and time off from work. As many as 20% of headaches are classified as cervicogenic headaches (CH). Chiropractic physicians have reported excellent results on CH using cervical and thoracic spinal manipulation (SM). However, mobilization has also been reported as being successful in managing CH. This study demonstrates that cervical … Read more
- Encephalopathy and Delirium from AntibioticsEncephalopathy and Delirium from Antibiotics TAKE-HOME MESSAGE Antibiotics, as a class of drugs, are under-recognized as a cause of deliriumand other brain problems. Researchers from Harvard Medical School conducted a comprehensive review of the clinical, radiologic, and electrophysiologic features of antibiotic-associated encephalopathy (AAE). They analyzed case reports on 391 patients over 70 years who were administered antibiotics and later developed delirium and other brain problems. Over 50 different antibiotics were studied from 12 different classes ranging from … Read more
- Exercise Improves Mood, Cognition, and Sleep in Parkinson’sExercise Improves Mood, Cognition, and Sleep in Parkinson’s Disease Open Access here TAKE-HOME MESSAGE Parkinson’s patients suffer with mood disorders, cognition and sleep disorders as components of their condition. This paper demonstrates how and why regular exercise is a major aid in managing the concurrent symptoms of mood disorders, poor cognition and impaired sleep. Overall, aerobic and strength training appears to be beneficial for these non-motor findings and have an excellent side-effect profile. Several mechanisms … Read more
- Neck Pain and HeadacheNeck Pain and Headache TAKE-HOME MESSAGE Headaches remain a significant disorder suffered by the public. The estimated global one-year period prevalence for headache is about 10% for migraine and about 38% for tension-type headache (TTH) This study measures the high association between neck pain and pure TTH (88.4%) and TTH plus migraine (89.3%) This finding does not surprise chiropractic neurologist and confirms in research what is commonly observed in the clinical setting. Chiropractic physicians with an … Read more
- New Form of Charcot-Marie-Tooth Disease IdentifiedNew Form of Charcot-Marie-Tooth Disease Identified TAKE-HOME MESSAGE Charcot-Marie-Tooth (CMT) disease is a dystrophy with an ever-growing list of genetic etiologies. The authors describe a new type of CMT that presents as an axonal motor and sensory neuropathy caused by mutations in the microrchidia family CW-type zinc finger 2 (MORC2) gene. Two types of this syndrome are described, one with early onset presenting as a spinal muscular atrophy–like disease, another with later onset that starts … Read more
- TBI, Inflammation and Brain DiseaseTBI, Inflammation and Brain Disease TAKE-HOME MESSAGE Traumatic brain injury (TBI) has been found to lead to a host of chronic neurodegenerative disorders Neuroinflammation may be the cause of the chronic disease state of the brain and subsequent brain degeneration. Pharmacologic therapies are discussed Nutritional options of controlling brain inflammation should be encouraged by all physicians managing patients involved in collision sports and patients suffering TBI from falls and accidents. Abstract It has long been suggested … Read more
- Low Frequency Sound Improves FibromyalgiaLow Frequency Sound Improves Fibromyalgia TAKE – HOME MESSAGE Fibromyalgia morbidity continues to plague 2-4% of the population, 80 percent of victims are women. There is currently no cure for Fibromyalgia and the best treatment approaches tend to be a blend of pharmacology and non-pharmacological treatments. Abnormalities in pain processing have been identified at various levels in the peripheral, central and sympathetic nervous systems, as well as the hypothalamo-pituitary-adrenal axis stress-response system. Nineteen females with … Read more
- Apathy, Depression, and White Matter ChangesApathy, Depression, and White Matter Changes TAKE-HOME MESSAGE Apathy and depression are common morbidities related to cerebrovascular disease. Clinically, the two are often difficult to differentiate, and there is clear overlap. The authors used MRI imaging to assess the relationship between white matter disruption and depression, apathy, and cognitive impairment. Then they investigated particular brain regions associated with the symptoms using whole-brain voxel-based analysis. The authors found that, in patients with small-vessel disease, the prevalence … Read more
- Coconut Oil in Prevention of Alzheimer’s DiseaseCoconut Oil in Prevention of Alzheimer’s Disease TAKE-HOME MESSAGE Alzheimer’s disease (AD) is a complex disease that progresses over many years, such as diabetes, heart disease and other chronic A number of factors may increase or decrease an individual’s chances of developing the AD, including age, genetics, environment, lifestyle and metabolic diseases. Coconut may be beneficial in the treatment of obesity, dyslipidemia, elevated LDL, insulin resistance and hypertension – these are the risk factors for … Read more
- Open Letter to Non-Member NeurologistsDear Neurologist, The International College of Chiropractic Neurology (ICCN) is reaching out to chiropractic physicians credentialed in neurology with an offer for membership in our organization. The ICCN was formed as and evidence informed neurology association and credentialing board for chiropractic neurologists. We are currently accepting neurologist for membership credentialed by the following boards: American Chiropractic Neurology Board (DACNB) International Board of Chiropractic Neurology (DIBCN) American Chiropractic Academy of Neurology (DACAN) Chiropractic Board of … Read more
- Vitamin E and Alzheimer’s DiseaseVitamin E and Alzheimer’s Disease [Article in Japanese] TAKE-HOME MESSAGE Oxidative Stress has been suggested as a causative factor in the development of Alzheimer’s disease Vitamin E, an antioxideant, has been recommended in the prevention or treatment for Alzheimer’s disease. Studies have demonstrated a decrease in cognative decline for Alzheimer’s patients treated with vitamin E, but no cognative improvement for patients with mild cognative impairment. Further studies are needed to establish a role for vitamin E in the treatment or … Read more
- The Basis for Restoring Function Following Spinal Cord InjuryThe Basis for Restoring Function Following Spinal Cord Injury TAKE-HOME MESSAGE Neurologists who are interested in the restoration of function of patients suffering spinal cord injuries must fully understand the normal function of the spinal cord and identify the specific structures that are injured There are very different problems that a patient will face following spinal cord injury and they are based on the exact structures that are damaged and the impaired physiology. This review … Read more
- Rivermead and Trail-Making Tests Reliably Predict Concussion RecoveryRivermead and Trail-Making Tests Reliably Predict Concussion Recovery TAKE-HOME MESSAGE Concussion diagnosis and management continues to be a source of concern for clinicians and there remains a need for valid instruments to predict concussion recovery The Rivermead Post Concussion Symptom Questionnaire (RPQ) and the Trail-making test (TMT) have been proven by this study to substantially predict moderate to severe limitations. The RPQ and TMT instruments are easy to administer and may be helpful to clinicians … Read more
- Chiropractor Identifies Dissection in ProcessChiropractor Identifies Dissection in Process TAKE-HOME MESSAGE Neck pain and headache are common complaints that respond well to chiropractic cervical manipulation. Cervical manipulation has recently been blamed as a causative factor in vertebral artery dissections. Vertebral artery dissection in process primarily presents as neck pain and headache. Recent research suggests that cervical manipulation does not cause vertebral artery dissections but that patients with dissections in process enter with neck pain and headache and the dissection is … Read more
- Metformin May Lead To Peripheral NeuropathyMetformin May Lead To Peripheral Neuropathy TAKE-HOME MESSAGE Patients with diabetes fear diabetic neuropathy and often treat their diabetic condition with Metformin. It is known that Metformin lowers serum vitamin B12 and increases methylmalonic acid (MMA). MMA is a gold standard biomarker for B12 deficiency. MMA has been shown to damage the dorsal root ganglia This study demonstrates that the B12 deficiency caused by Metformin leads to an increased risk for peripheral neuropathy. Alternatives to Metformin … Read more
- Low Vitamin D Associated With Accelerated Cognitive DeclineLow Vitamin D Associated With Accelerated Cognitive Decline From JAMA Neurology TAKE-HOME MESSAGE In this study, Hispanic and African-American study participants had lower Vitamin D (VitD) levels than whites. Lower VitD levels was associated with accelerated Cognitive decline. This study did not evaluate whether D2 or D3 supplementation would prevent or reduce cognitive decline. That has yet to be established. The wise neurologist ensures that 25HOD levels are in the range of 40-50 ng/mL Abstract … Read more
- Statin Therapy May Impair MemoryStatin Therapy May Impair Memory TAKE-HOME MESSAGE A comparison was performed between patients on statin Lipid Lowering Drugs (LLDs), people on non-statin LLDs and controls. There was found a strong association between initiation of LLD therapy using statins and non-statins and acute memory loss within 30 days of starting therapy. Unfortunately, both statin and non-statin therapy groups demonstrated memory impairment It is not clear at this point whether the LLD therapy caused the memory loss or … Read more
- Intracranial Hypotension and CMTIntracranial Hypotension and CMT TAKE-HOME MESSAGE Intracranial Hypotension (IH) is a common sequela following lumbar puncture. Rarely, there are reports of IH following even minor neck trauma. It is hypothesized that neck trauma may cause slight tears in dural structures resulting in IH. Case reports have suggested that chiropractic manipulative therapy (CMT) has led to IH and that patients suffering IH should be questioned regarding exposure to CMT. This review highlights the poor quality of … Read more
- Tai Chi Improves Parkinson’s SymptomsTai Chi Improves Parkinson’s Symptoms TAKE-HOME MESSAGE Immobility and balance disturbances are suffered by Parkinson’s patients. This study compared balance and mobility for Parkinson’s patients following a Tai Chi program. The study participants were highly satisfied with the Tai Chi program. Balance and mobility were improved by Tai Chi exercises. Abstract BACKGROUND AND OBJECTIVE: In Parkinson’s disease (PD), wearing off and side effects of long-term medication and complications pose challenges for neurologists. Although Tai Chi … Read more
- Childhood Concussion Symptoms May LingerChildhood Concussion Symptoms May Linger TAKE-HOME MESSAGE Childhood concussion, recovery from mild traumatic brain injury (mTBI) and return to play guidelines remain a serious point of discussion in the healthcare community. In this study, 11.8% of patients remained symptomatic 3 months after the injury. A subset of patients had symptoms return after resolution. Inconsistent reporting of symptoms between patients and caregivers was identified. ABSTRACT BACKGROUND Improving our knowledge about the natural history and persistence of … Read more
- Older individuals Recover Slower from ConcussionOlder individuals Recover Slower from Concussion TAKE-HOME MESSAGE Functional MRI has been used recently to more clearly understand brain function In this study, fMRI was used to measure the working memory of persons suffering mild traumatic brain injury (mTBI) Younger patients showed a tendency for greater post-concussive symptoms Older individuals demonstrated a slower recovery rate from mTBI Younger patients may have greater neuroplasticity. Abstract Purpose To evaluate the age effect on working memory (WM) performance … Read more
- No Neck Artery Damage From Chiropractic ManipulationNo Neck Artery Damage From Chiropractic Manipulation TAKE-HOME MESSAGE Chiropractic physicians have been accused of damaging arteries in the neck with spinal manipulation. Recent epidemiologic studies have called that assertion into question. In fact, research has proven that exposure to chiropractic manipulation causes no more damage to neck arteries than exposure to a general medical practitioner. In this study, researchers measure the stress placed on vertebral arteries during cervical ROM and during manipulation. Manipulation places … Read more
- Brain Abnormalities and TinnitusNeuroscientists at Georgetown University Medical Center and Germany’s Technische Universität München suggest a brain abnormality may be responsible for tinnitus and for chronic pain. The researchers postulate that neural mechanisms that normally “gate” or control noise and pain signals can become dysfunctional. Tinnitus can occur after the ears are damaged by loud noise, but even after the injury has resolved and the brain has reorganizes itself, it continues to “hear” a constant hum. This can also be true … Read more
- Statin Myopathy: Recognizing a Unique PhenotypeIntroduction: Most cases of muscle symptoms associated with statin use are a direct (toxic) effect of the statin on muscle tissue, typically begin in proximity to the initiation of statin therapy, and resolve after the statin is discontinued. Statin-associated autoimmune necrotizing myopathy (S-ANM), an immune-mediated disease is a relative new comer to the range of statin induced myopathic disorders. It’s unique features lead to difficulty in both diagnosis and treatment. The key features of S-ANM, … Read more
- Diagnosing Parkinson’s using Clinical and Genetic ClassificationDiagnosing Parkinson’s using Clinical and Genetic Classification TAKE-HOME MESSAGE Chiropractic neurologists often see patients with Parkinson’s disease due to the stiffness that accompanies the condition. Often the chiropractic neurologist is the first person to suspect Parkinson’s as a diagnosis. In this study, the authors developed a classification model for diagnosing Parkinson’s disease. The model was developed using information from the Parkinson’s Progression Marker Initiative and was tested on 825 Parkinson’s patients and 261 controls. The model … Read more
- A Patient’s Beliefs About Back Pain Control RecoveryA Patient’s Beliefs About Back Pain Control Recovery TAKE-HOME MESSAGE Past studies have proven that a patient’s perceptions about the nature of back pain have been found to be more predictive of the development of chronicity and disability than the nature of injury. Though this study is small, it confirms the previous research findings…. A person’s beliefs about back pain control the patient’s recovery. If the patient fears the chronicity disability, it will more than … Read more
- Insulin Dysregulation May Impair Glucose Metabolism in BrainInsulin Dysregulation May Impair Glucose Metabolism in Brain Take Home Message: An imaging study of participants at risk for Alzheimer’s disease (AD) has found that insulin resistance was associated with lower regional cerebral glucose metabolism, and that “this information will be central to developing prevention and treatment therapies centered on insulin dysregulation.” This cohort study shows that insulin resistance may be associated with neurocognitive deficits, especially memory deficits when the glucose metabolism dysfunction is present in … Read more
- Chiropractic Manipulation Not Associated With VBA StrokeChiropractic Manipulation Not Associated With VBA Stroke TAKE-HOME Message Spinal Manipulative Therapy (SMT) has been accused of causing vertebrobasilar dissection (VBD) and stroke. In his Ontario study, Cassidy found an association between VBD and chiropractor visits, but the association was identical to the association between VBD and primary care provider (PCP) visits. This led to the conclusion that there was no causal relationship between SMT and VBD. It was determined that patients with a VBD … Read more
- Lipid Lowering Drugs and Acute Memory ImpairmentLipid Lowering Drugs and Acute Memory Impairment TAKE-HOME MESSAGE In this article, a strong association was identified between initial lipid lowering drugs (LLDs) and diagnosis of acute memory loss within 30 days of therapy onset. The results show that the use of both statins and non-statin LLDs both increased the risk of acute memory loss in 30 days compared with controls. These results may indicate that all LLDs cause acute memory loss. Abstract IMPORTANCE Reports … Read more
- A New Noninvasive Tinnitus TreatmentA New Noninvasive Tinnitus Treatment TAKE-HOME MESSAGE The authors of this article use a technique they call Multimodal Synchronization Therapy (MST) to manage tinnitus The therapy uses multiple sensory, motor, limbic and cognitive inputs to elicit activation of multimodal neurons to potentially modulate specific neurons driving the perception of tinnitus. This article encourages chiropractic neurologists seeking conservative methods to alter CNS processing to improve health. A new concept for noninvasive tinnitus treatment utilizing multimodal pathways. … Read more
- Brain Hemorrhage Risk Increases With Antidepressants and NSAIDsBrain Hemorrhage Risk Increases With Antidepressants and NSAIDs TAKE-HOME MESSAGE Chiropractic Neurologists often see patients suffering with chronic pain treated by NSAIDS and antidepressants womans health info The risk of intracranial hemorrhage within 30 days of drug use was greater for individuals treated with a combination of an antidepressant and an NSAID than for individuals receiving antidepressant therapy alone. Concurrent treatment with antidepressants and NSAIDs was associated with a greater risk of intracranial hemorrhage within … Read more
- Laser Therapy New Treatment for Traumatic Brain Injuries?Laser Therapy New Treatment for Traumatic Brain Injuries? Take Home Message: Low Level Laser Therapy (LLLT) shows promise in promoting healing of the injured areas of the brain following traumatic brain injuries. These initial laboratory studies are now being followed up with clinical studies LLLT is a conservative mode of therapy in many chiropractic offices. The Chiropractic Neurologist who is trained in diagnosing brain injuries may now have a potential modality that can minimize the effects of … Read more
- Cervical manipulation does not cause stroke in elderly.Cervical manipulation does not cause stroke in elderly. TAKE-HOME MESSAGE This is the first study exclusively evaluating the stroke association with CMT in the elderly patient. An evaluation was performed on 1,157,475 Medicare part B enrollees in 2007 There was no increased association of stroke when chiropractic physicians treated an elderly person with neck pain than when a primary care physician treated an elderly with neck pain. Conclusion: Chiropractic treatment of neck pain does not result … Read more
- Spinal Cord NeuroplasticityTAKE-HOME MESSAGE The spinal cord participates in the execution of skilled movements by translating signals from the cerebral cortex to the peripheral nervous system and ultimately to the muscular system. Emerging information suggests that the spinal cord does more than act as a passive relay of information from the cortex to the muscles. The spinal cord appears to have an intrinsic ability to learn and undergo neuroplastic changes – findings that may yield new insights for … Read more
- Better Classification for Low Back Pain.Better Classification for Low Back Pain. TAKE-HOME MESSAGE • Low back pain (LBP) is often classified based on perceived tissue damage. However, sub-acute and chronic pain is often not nociception based, but drifts to central pain mechanisms. Neuropathic pain further confounds the picture. • Chiropractic neurologists who work with LBP would do themselves and their patients a great favor if they would classify the pains based on a new approach. • This article suggests that LBP be classified … Read more
- Ulnar Neuropathy: Localization Corresponds to Etiology and PathologyKey Points: Occupation and age may be predictive of the location and extent of pathology seen in Ulnar neuropathies. Ulnar neuropathies found in the dominant arm are more commonly axonal, localized to the humero-ulnar aponeurotic arcade, and associated with repetitive or forceful manual activities. Those in the non-dominant arm are more typically demyelinating, localized to the retro-condylar region, and associated with external compression in younger administrative workers. Precise localization of an Ulnar neuropathy may require … Read more
- Skin Lesions Help To Diagnose Neuromuscular DisordersSkin Lesions Help To Diagnose Neuromuscular Disorders TAKE-HOME MESSAGE The incidence of skin lesions are found to be elevated in a number of NMDs, including dermatomyositis, myotonic dystrophies, mitochondrial disorders, muscular dystrophies, and neuropathies. Chiropractic neurologists should be reminded to examine the skin of patients when neuromuscular disorders are suspected. Dermatologists may need to be consulted to manage the skin lesions identified. Abstract OBJECTIVES A thorough evaluation of the skin and its appendages is frequently … Read more
- Vestibular Rehab Helps Combat Related PTST and mTBI patients.Vestibular Rehab Helps Combat Related PTST and mTBI patients TAKE-HOME MESSAGE Combat veterans with PTSD from mild traumatic brain injury (mTBI) may improve via vestibular rehabilitation This article tends to confirm PTSD following mTBI is a physical ailment rather than a psychiatric disorder Vestibular rehabilitation was altered to address the individual patient’s presentation. This article adds to the evidence that vestibular rehabilitation has a role in managing mTBI and PTSD. ABSTRACT INTRODUCTION: Blast-related head … Read more
- Pathological Changes Confirm the Neuropsychiatric Sequel to mTBIPathological Changes Confirm the Neuropsychiatric Sequelae to mTBI TAKE-HOME MESSAGE There is now evidence of the neuropsychological sequelae related to mild traumatic brain injury (mTBI). Therefore it is imperative to inquire with your post-concussive patients and their family about behavior changes along with utilization of outcome measures, such as post-concussive assessment tools to detect these problems on initial presentation. This recent study with utilization of Diffusion Tension Imaging reveals changes in deep cerebral axonal degeneration … Read more
- Cervical Manipulation Does Not Damage Healthy Vertebral Arteries.Cervical Manipulation Does Not Damage Healthy Vertebral Arteries. TAKE-HOME MESSAGE In this study, mechanical stress/strain on cervical arteries was measured while the cervical spine was taken through ROM and through manipulation. Cervical rotation placed the vertebral arteries under more stress than manipulation. Manipulation was less stressful on vertebral arteries than cervical ROM and stress from both movements were well below published vertebral artery failure rates. Background: Spontaneous vertebral artery dissection has significant mortality and morbidity … Read more
- Omega – 3 Fatty Acid Supplementation Post Mild Traumatic Brain InjuryTake Home Message: Dietary supplementation with DHA (omega – 3 fatty acid) may act as a recovery aid, or possibly as a prophylactic nutritional measure, for mild traumatic brain injury. Chiropractic Neurologists engaged in the evaluation of mild traumatic brain injury/concussion may consider Omega – 3 fatty acid supplementation to be a potentially beneficial adjunct to case management. Abstract: Sports-related concussions or mild traumatic brain injuries (mTBIs) are becoming increasingly recognized as a major public health concern; … Read more
- Can Fish Oil Prevent Aneurysmal Subarachnoid Hemorrhage?TAKE-HOME MESSAGE Cerebral aneurysm formation is facilitated by inflammation. This article posits that aspirin is a cost effective treatment for patients with cerebral aneurism where surgery would be high risk or for those who have low risk of rupture. Since fish oil supplementation has been proven to have equal anti-inflammatory capacity of NSAIDs, is it time for neurologists to advocate for fish oil for patients in prevention of cerebral aneurysm or for treatment for aneurysm … Read more
- Case StudyA 5-Year-Old Girl With Headache and Vomiting Published in Medscape and shared by Dr. Wini Hamilton Background A 5-year-old girl presents to the emergency department with a severe headache and projectile vomiting for the past 4 hours. Her mother denies any history of trauma to the head or any recent infection or vaccination, and she states that her daughter did not have a fever or chills. The mother also reports no diarrhea or signs of … Read more
- Neuropathy Found in Celiac PatientsNew from JAMA Neurology TAKE-HOME MESSAGE Neuropathy patients deserve to know the cause of their neuropathy if it can be identified Celiac disease has been found to cause neuropathy and must be placed on the differential for these patients. Abstract Importance Earlier research on celiac disease (CD) and neuropathy has been hampered by the use of inpatient data, low study power, and lack of neuropathic characteristics. Objective To examine the relative risk and absolute risk … Read more
- Nutritional Supplement may Improve Symptoms of Carpal Tunnel SyndromeFrom Int J Immunopathol Pharmacol TAKE-HOME MESSAGE The authors compared efficiency of shock wave therapy versus nutraceutical composed of alpha lipoic acid, conjugated linoleic acid, anti-oxidants and Echinacea angustifolia for carpal tunnel syndrome A trend to better pain regression was identified in the nutraceutical group Abstract Even though the initial treatment of carpal tunnel syndrome (CTS) is conservative, knowledge of the clinical effects of supplements and of some methods of physiotherapy is still preliminary. Many … Read more
- No Gain for Stenting in Symptomatic Vertebral Artery StenosisFrom Lancet Neurology TAKE-HOME MESSAGE The authors evaluated the safety and feasibility of stenting in patients with a recent transient ischemic attack (TIA) or minor stroke associated with an intracranial or extracranial vertebral artery stenosis of at least 50% because these patients are at high risk for future vertebrobasilar stroke. The risk for recurrent vertebrobasilar stroke in patients receiving control medical treatment in this trial was low and similar to that observed in patients receiving … Read more