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Changes in cerebellar blood flow after manipulation of the cervical spine using technetium 99m-ethyl cysteinate dimer

Barbara Cagnie (UGent) , Filip Jacobs (UGent) , Erik Barbaix, Elke Vinck, Rudi Dierckx (UGent) and Dirk Cambier (UGent)
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Abstract
Background: Cervical spine manipulation is one of the many interventions practiced by health professionals to treat musculoskeletal disorders of the cervical spine. Although serious consequences of manipulation have been documented, the incidence is thought to be rare. More frequently, there may be minor transient side effects after manipulation of the cervical spine, such as headache, dizziness, and nausea. One of the hypothesis is that these side effects are caused by ischemia in the areas perfused by the vertebral arteries. Objective: The purpose of this study was to investigate whether manipulation of the cervical spine can influence blood flow in the brain. Methods: Single photon emission computed tomography was used to examine changes in regional cerebral blood flow caused by cervical spine manipulation (CSM) performed by a physiotherapist to 15 volunteers, using a 1-day split-dose Technetium 99m-ethyl cysteinate dimer single photon emission computed tomography activation paradigm. Results: One brain region was identified showing a decreased regional cerebral blood flow after manipulation. This region was situated in the anterior lobe of the left cerebellum (-42, -48, -24). Conclusions: These findings suggest that cerebellar hypoperfusion may occur after CSM. This could explain why certain people experience headache, dizziness, or nausea after CSM. Further investigation into patient symptoms in the presence of cerebellar hypoperfusion and the possible link of these findings with other adverse reactions are warranted.
Keywords
manipulation, single-photon, emission-computed, neck, regional blood flow, tomography, THERAPY, ROTATION, COMPLICATIONS, VERTEBRAL ARTERY FLOW, hypoperfusion

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MLA
Cagnie, Barbara, Filip Jacobs, Erik Barbaix, et al. “Changes in Cerebellar Blood Flow After Manipulation of the Cervical Spine Using Technetium 99m-ethyl Cysteinate Dimer.” JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS 28.2 (2005): 103–107. Print.
APA
Cagnie, Barbara, Jacobs, F., Barbaix, E., Vinck, E., Dierckx, R., & Cambier, D. (2005). Changes in cerebellar blood flow after manipulation of the cervical spine using technetium 99m-ethyl cysteinate dimer. JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS, 28(2), 103–107.
Chicago author-date
Cagnie, Barbara, Filip Jacobs, Erik Barbaix, Elke Vinck, Rudi Dierckx, and Dirk Cambier. 2005. “Changes in Cerebellar Blood Flow After Manipulation of the Cervical Spine Using Technetium 99m-ethyl Cysteinate Dimer.” Journal of Manipulative and Physiological Therapeutics 28 (2): 103–107.
Chicago author-date (all authors)
Cagnie, Barbara, Filip Jacobs, Erik Barbaix, Elke Vinck, Rudi Dierckx, and Dirk Cambier. 2005. “Changes in Cerebellar Blood Flow After Manipulation of the Cervical Spine Using Technetium 99m-ethyl Cysteinate Dimer.” Journal of Manipulative and Physiological Therapeutics 28 (2): 103–107.
Vancouver
1.
Cagnie B, Jacobs F, Barbaix E, Vinck E, Dierckx R, Cambier D. Changes in cerebellar blood flow after manipulation of the cervical spine using technetium 99m-ethyl cysteinate dimer. JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS. 2005;28(2):103–7.
IEEE
[1]
B. Cagnie, F. Jacobs, E. Barbaix, E. Vinck, R. Dierckx, and D. Cambier, “Changes in cerebellar blood flow after manipulation of the cervical spine using technetium 99m-ethyl cysteinate dimer,” JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS, vol. 28, no. 2, pp. 103–107, 2005.
@article{303639,
  abstract     = {Background: Cervical spine manipulation is one of the many interventions practiced by health professionals to treat musculoskeletal disorders of the cervical spine. Although serious consequences of manipulation have been documented, the incidence is thought to be rare. More frequently, there may be minor transient side effects after manipulation of the cervical spine, such as headache, dizziness, and nausea. One of the hypothesis is that these side effects are caused by ischemia in the areas perfused by the vertebral arteries. 
Objective: The purpose of this study was to investigate whether manipulation of the cervical spine can influence blood flow in the brain. 
Methods: Single photon emission computed tomography was used to examine changes in regional cerebral blood flow caused by cervical spine manipulation (CSM) performed by a physiotherapist to 15 volunteers, using a 1-day split-dose Technetium 99m-ethyl cysteinate dimer single photon emission computed tomography activation paradigm. 
Results: One brain region was identified showing a decreased regional cerebral blood flow after manipulation. This region was situated in the anterior lobe of the left cerebellum (-42, -48, -24). 
Conclusions: These findings suggest that cerebellar hypoperfusion may occur after CSM. This could explain why certain people experience headache, dizziness, or nausea after CSM. Further investigation into patient symptoms in the presence of cerebellar hypoperfusion and the possible link of these findings with other adverse reactions are warranted.},
  author       = {Cagnie, Barbara and Jacobs, Filip and Barbaix, Erik and Vinck, Elke and Dierckx, Rudi and Cambier, Dirk},
  issn         = {0161-4754},
  journal      = {JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS},
  keywords     = {manipulation,single-photon,emission-computed,neck,regional blood flow,tomography,THERAPY,ROTATION,COMPLICATIONS,VERTEBRAL ARTERY FLOW,hypoperfusion},
  language     = {eng},
  number       = {2},
  pages        = {103--107},
  title        = {Changes in cerebellar blood flow after manipulation of the cervical spine using technetium 99m-ethyl cysteinate dimer},
  url          = {http://dx.doi.org/10.1016/j.jmpt.2005.01.005},
  volume       = {28},
  year         = {2005},
}

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