Catherine Jones

Vertebral artery dissection after a chiropractor neck manipulation.

The differential diagnosis for ischemic central nervous system infarcts in young patients includes paradoxic emboli through cardiac shunts, vasculitis, and vascular trauma. We report a young woman who developed headache, vomiting, diplopia, dizziness, and ataxia following neck manipulation by her chiropractor. A computed tomography scan of the head revealed an infarct in the inferior half of the left cerebellar hemisphere and compression of the fourth ventricle causing moderate acute obstructive hydrocephalus. Magnetic resonance angiography revealed severe narrowing and low flow in the intracranial segment of the left distal vertebral artery. The patient was treated with mannitol and a ventriculostomy and had an excellent functional recovery. This report illustrates the potential hazards associated with neck trauma, including chiropractic manipulation. The vertebral arteries are at risk for aneurysm formation and/or dissection, which can cause acute stroke.

Platelet Function Analysis Using PFA-100 Tests in Patients With Acute Gastrointestinal Bleeding

Aim. To investigate platelet function in patients with acute gastrointestinal bleeding. Methods. We prospectively studied platelet function using the PFA-100 test in a convenience sample of patients with gastrointestinal bleeding admitted to the medical ICU from July 2010 to August 2011. Patients on warfarin or heparin were excluded. Results. In all, 41 patients (30 men) participated in the study. The mean age was 55 years (range 25-74 years). Most patients (31/41) presented with blood in their stools as at least one of their presenting symptoms. Fourteen of the 41 patients were on aspirin, 4 on nonsteroidal anti- inflammatory drugs, and 5 on clopidogrel or other antiplatelet drugs. The average hemoglobin was 9.2 g/dL (range 5.1-16.1 g/dL). The average platelet count was 170 kU/L (range 41-496 kU/L). The average international normalized ratio was 1.37(range 1.01-2.08). Analysis of platelet function was performed in 9 patients (22%). These patients had closure times which ranged from 98 to >300 seconds wit...