Chiropractic Response to a Spontaneous Vertebral Artery Dissection

OBJECTIVE: The purpose of this case report is to describe a case in which early detection and proper follow-up of spontaneous vertebral artery dissection led to satisfactory outcomes. CLINICAL FEATURES: A 34-year old white woman reported to a chiropractic clinic with a constant burning pain at the right side of her neck and shoulder with a limited ability to turn her head from side to side, periods of blurred vision, and muffled hearing. Dizziness, visual and auditory disturbances, and balance difficulty abated within 1 hour of onset and were not present at the time of evaluation. A pain drawing indicated burning pain in the suboccipital area, neck, and upper shoulder on the right and a pins and needles sensation on the dorsal surface of both forearms. Turning her head from side-to-side aggravated the pain, and the application of heat brought temporary relief. The Neck Disability Index score of 44 placed the patient’s pain in the most severe category. INTERVENTION AND OUTCOME: The patient was not treated on the initial visit but was advised of the possibility of a vertebral artery or carotid artery dissection and was recommended to the emergency department for immediate evaluation. The patient declined but later was convinced by her chiropractor to present to the emergency department. A magnetic resonance angiogram of the neck and carotid arteries was performed showing that the left vertebral artery was hypoplastic and appeared to terminate at the left posterior inferior cerebellar artery. There was an abrupt moderately long segment of narrowing involving the right vertebral artery beginning near the junction of the V1 and V2 segments. The radiologist noted a concern regarding right vertebral artery dissection. Symptoms resolved and the patient was cleared of any medications but advised that if symptoms reoccurred she was to go for emergency care immediately. CONCLUSION: Recognition and rapid response by the chiropractic physician provided the optimum outcome for this particular patient

Lining Up: Ensuring Equal Access to the Right to Vote

Election Day 2012 marked the convergence of three historic factors: the re-election of the country’s first African-American president, an unprecedented spate of suppressive voting laws passed or proposed in a majority of states, and a demonstration of the resolve and dedication of American voters who turned out and voted despite efforts to deter participation. New restrictive voting measures threatened to obstruct voter participation and inclusion on Election Day. State legislatures introduced or passed restrictive photo ID laws and other suppressive legislation that presented hurdles to voters—disproportionately voters of color and the poor—who lacked the documents, funds or time to obtain the newly-required ID to vote. Additionally, measures reducing early voting periods inconvenienced many voters, including African Americans, who in states like Florida, rely more heavily on the early voting period than other racial groups. This report discusses the fight back in the war on voting, the problems experienced by voters of color when voting in 2012, and recommends needed reforms. The report also highlights that in 2013, various state legislatures are continuing to propose restrictive voting measures. Released in the wake of the Supreme Court’s June 2013 decision in Shelby County v. Holder finding the Section 5 coverage formula of the Voting Rights Act unconstitutional, the Lawyers’ Committee and Advancement Project’s report chronicles the impact of restrictive voting laws on voters of color in the 2012 election. The report includes heroic stories culled from litigation documents, reports called into the 866-OUR-VOTE hotline, and interviews of real people adversely affected by restrictive voter laws and their efforts to exercise the right to vote. Considering that at least 36 states introduced restrictive voting laws in 2013, this report demonstrates the continued need for, and enforcement of, federal and state laws protecting the right to vote, coupled with voter vigilance to ensure the right to vote is not undermined. This report not only highlights the challenges that voters of color face, but also provides real solutions for progress and increased voter participation. It makes the case for the need for improvements in election administration and continued outreach, education, advocacy, and litigation in order to defend the right to vote for people of color