Dr W.N. Dudley, D. C. Howell, Michigan
Cerebrovascular studies are generally considered with the delineation of syndromes of the cranial vault and its arteries. However, Cooper' in 1836 reported blockage of the carotid artery and its importance relative to the supply of the brain. It was Hutchinson and Yates who related that intracranial infarction was due more to stenosis of the extra cranial arteries than the intracranial arteries. Schwartz and Mitchell3 found that stenosis of the vessels of the neck did not necessarily lead to cerebral infarction, but they established a relationship between occlusion of these arteries and cerebral infarction.
Wood4 in 1965 first demonstrated the usefulness of thermography in cerebrovascular diseases. The unequal display on thermographic scans indicates an improper supply.5 The possibility of carotid artery occlusion and/or disturbance of flow is obvious. An impending cerebrovascular accident can be predicted from such disparity noted on the thermogram. The consideration here is the possibility that the carotid artery flow could be occluded by a traction upon the artery by the scalenus anticus muscle in the neck unilaterally.
Thermography is a refined form of thermometry with the allowance that small changes in the thermal pattern can be noted with great speed. The patient can be scanned repeatedly without harm and with a great deal of precision to determine possible ischemia. Temperature alteration can be noted and, when using a thermography unit capable of isobaric measurement, the disparity can be measured.* That is, the thermal difference can be noted and with relative precision can be measured to fractions of a degree.
The skin temperature of a patient can vary due to clothing, hair and ambient temperature. Therefore, care must be exercised to remove any thermal impediments. Also, the room in which the scans are done must have draft-free ventilation. The patient should remain in the draft-free surroundings until his vascular system has adjusted. Then infrared thermography will accurately exhibit the changes in the blood flow.
It was with these considerations in mind that routine scanning of patients was done thermographically. The possibility of carotid artery traction and cerebrovascular occlusion often existed without the patient's realizing it. If the patient exhibited a positive Adson's test, this sign was sufficient reason to conclude that there was indeed traction to the carotid artery. The amount of that traction then could be defined by a thermogram. It was noted that a positive Adson's test was exhibited often but did not necessarily cause harmful effects upon the cerebral supply to any obvious degree.
It was in the middle-aged patient and older that prime consideration was given for possible ischemia of the supraorbital and superficial temporal artery supply, keeping in mind the possibility of traction upon the carotid artery by the scalenus anticus as a prime offender.
Because the face is supplied by the external carotid artery, we have placed more emphasis upon this distribution. Again various branches of this carotid artery supply the deeper regions of the skull but they are reflections of that circulation and possible occlusions to that circulation.
It should be noted here that an infarct may occur in the superficial temporal or the supraorbital. This is not superfluous but for the purpose of this paper, consideration is given to the fact that traumatically induced infarcts were not seen in this study.
It is the mechanical pressure of prolonged continuous traction of the scalenus anticus upon the carotid that would necessarily cause an alteration of blood flow to the brain of that side and lead to possible insufficiency, rupture or infarction in the cerebral arteries. If that can occur, as is obvious by thermography, then the relief of that mechanical pressure by means of an adjustment of the cervical spine should be detectable by thermography. The stimulus to the cervical spine by means of the adjustment may alter and improve the flow to the cerebral arteries by releasing the traction upon the carotid artery, but of more concern is the durability of the effect of that adjustment over a period of time,
Inasmuch as the author does not specialize in vascular disorders, the conclusions were reached from a limited number of frank vascular disorders. From the patient's general presentation of diverse complaint, we may observe the problem of vascular insufficiency even though we are not specifically looking for this condition. The recognition of impending vascular problems needs no specialized training, only the ability to use thermographic equipment and also to have thermography available to the clinician.
Only three cases are presented here and they are not meant to represent the percentage of cases of this condition seen in general practice. These cases are not exemplary but are merely ones in which no technical error with the thermographic equipment was committed. We have noted several cases of varying ischemia. They have been resolved quite well and throughout follow-up have remained uneventful.
Case #1 Figures #1 and #2 show an entering thermogram of a 58-year-old female patient who presented no specific symptoms, However, the heat disparity is obvious. The rescan figures ;#3 and#4 show more even display. The scan adjustment rescan time lapse was approximately four minutes. Adjustment was made to the mid-cervical spine in a cervical chair.
Case #2 is a married male, Caucasian, farmer by occupation. He had been hospitalized with a "nervous" complaint and had not been able to work for three years, Initial blood pressure was 120/100 left arm, 155/120 right arm, pulse 104, and a history of atresia of the right kidney which had been removed surgically, X-rays of the spine showed a generalized arthritic condition with moderate lipping and spurring, a left curve in the cervical spine, and a left scoliosis of the lumbar spine. Fasting muscle tests showed weakness in the right latissimus, teres major, gluteus maximus and the left gluteus minimum. He was withdrawn from sucrose and had quit smoking. A positive Adson's on the left was noted. Only one blood test returned with pathologic finding--the T4 was low. Considerable vertigo had been noted.
He had been examined by a surgeon who had suggested carotid artery surgery, which he refused, The adjustment centered around the mid and lower cervical spine, utilizing a cervical chair. Figures #5 and #6 show the disparity between circulation on the one side of the face. The lack of circulation on the right side is exhibited by the black area. Figures#7 and #8 show a comparatively equal density on each side of the face indicating a more even vascular flow.
He has returned to active life. The time from the initial scan to present is six months. Adjustments are made weekly.
Case #3 is a 64-year-old male, an attorney, and father of three children. Initial blood pressure in the right arm was 156/80, left arm 130/70, and at the time he was taking hypertension medication. He was experiencing vertigo, weakness and vocal loss along with erratic cardiac action. Eighteen months previously he had elevated triglyceride and cholesterol levels but dietary changes showed normal levels upon retesting.
He has been examined by one specialist for his vocal loss and another for the erratic cardiac action, but was told that no further action was necessary. He displayed a positive left Adson's test, and films of the spine showed a moderate arthritic spine not unusual for that age group. All blood tests done were negative, but he was concerned about his generalized malaise.
Figures #9 and #10 show an extreme lack of blood supply to the right side of the face whereas the left scan comparatively is normal. The adjustment utilized was that of mid and lower cervical done in a cervical chair and within 10 days the rescan pictures ,#11 and #12 showed that the blood supply to the face appeared to be normalizing. The erratic heart action has ceased and although he has a chronic cardiac hypertrophy, he no longer appears endangered by thermographic definition. The first scan was done four months previously; adjustments are every other week.
These cases are not presented as unusual or extraordinary. They are presented only to show that the application of adjustment has an apparent efficiency in the improvement of probable cerebrovascular problems. It must be stressed, however, that there is a technique for defining and evaluating this efficiency, and that is thermography.
Discussion of physical force applied to the carotid by the scalenus anticus might center around the concept that if the scalenus anticus can continuously apply traction upon the carotid artery, this would allow for an altered flow. This flow would not be reduced in volume but increased in pressure and thereby might be the basis for cerebrovascular rupture. It is an interesting question that certainly bears answer.
References
1. Cooper, A. P, Guys Hospital Reports, 1, 457, 1836.
2. Hutchinson, E. C, and Yatcs, P. P., Lancet, 1, 2, 1957.
3. Schwarh and Mitchell, J.R A, Brit. fled. J., 2, 19)7, 1961. 4. 37006, E. H., Radiology Vol. 85 (August 1965), p.-270. Mawdsley ct 21, Brit Med J., ~21, 1968.
4.Dudley, W. N "Findings Using Adson's Sign. ACA Journal of Chiropractic, Vol, 9, No, 11 (November 1972), pp. S87-88.
About The 'Author Dr. W.N. Dudley is a graduate of PaImer College of Chiropractic in Davenport, Iowa. He is a member of the American Chiropractic Association and the Michigan State Chiropractic Association and has practiced in Howell, Michigan for the past15 years.
The use of thermographic equipment in the detection of cerebrovascular problems is discussed in this paper. Three cases are presented to show the effects of chiropractic adjustment on and the apparent alleviation of these problems. The concept of continued traction of the scalenus anticus muscle upon the carotid artery inducing cerebrovascular infarct is considered.
*The author used an ACA Thermography Unit.
THE ACA JOURNAL OF CHIROPRACTIC, AUGUST 1974