Document Detail


Seventh cervical rib associated with subclavian artery occlusion and multiple infarcts: case report.
MedLine Citation:
PMID:  18578275     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A cervical rib, or supernumerary (extra) rib arising from the 7th cervical vertebra, is a congenital abnormality that occurs in less than 1% of the population. Clinically, it can cause obscure nervous or vascular symptoms and be difficult to diagnose. In this rare case, a 37-year-old woman developed a subclavian artery occlusion after undergoing a chiropractic manipulation for neck, shoulder, and arm pain. The occlusion led to multiple cerebellar infarcts, frontal subarachnoid hemorrhage, myocardial infarction, and right-hand vascular compromise. The patient was subsequently diagnosed with a 7th cervical rib, which likely caused compression of the subclavian artery after a hyperextension injury sustained during the chiropractic procedure. The departments of vascular surgery, neurosurgery, cardiology, and neurology collaborated to review all elements of the patient's diagnosis and care. After the patient was stabilized, she spent 6 weeks in acute inpatient rehabilitation; upon discharge, her symptoms were greatly improved but still present. Three months later, the patient underwent a subclavian-artery-to-axillary-artery bypass with resection of the left cervical rib. She tolerated surgery well with no complications. As a result of the devastating insults sustained secondary to the presence of the 7th cervical rib and her subclavian artery occlusion, this patient faced months of recovery. Treatment involved a structured interdisciplinary plan of care.
Authors:
Roxanne Wise
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses     Volume:  40     ISSN:  0888-0395     ISO Abbreviation:  J Neurosci Nurs     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-26     Completed Date:  2008-08-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8603596     Medline TA:  J Neurosci Nurs     Country:  United States    
Other Details:
Languages:  eng     Pagination:  169-72     Citation Subset:  IM; N    
Affiliation:
Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA. editor@mayfieldclinic.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Cerebellum / blood supply*
Cervical Rib Syndrome* / diagnosis,  etiology,  therapy
Female
Humans
Infarction* / diagnosis,  etiology,  therapy
Intensive Care / methods
Magnetic Resonance Imaging
Manipulation, Chiropractic / adverse effects
Neck Pain / complications,  prevention & control
Occupational Therapy
Patient Care Planning / organization & administration
Patient Care Team / organization & administration
Physical Therapy Modalities
Rare Diseases
Ribs / abnormalities*
Speech Therapy
Subclavian Artery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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