change in vertebral artery blood flow with change in head position CMC or after CMT and blood flow." When we think about this, this is again another important area, Herzog says, "We don't strain the artery enough to be able to damage it." Schievink says that "It's really not the intima that you need to be worried about. You need to think more about the media and externa." Now, [Triano 00:27:08] and company tell us, "In the process of adjustment, we don't cause a change in Bernoulli Principle or doing both Bernoulli Principle that we don't disrupt the blood flow, if the velocity stay the same and the flow pattern stay the same before, during, and after an adjustment in the vertebral artery in particular." Getting close to my time now that I can hear my host getting nervous on the other end, I'll take into one area … Emerging area of interest. This may sound like a stretch for some of you, but there is a developing body of may be ten or twelve case studies on the subject and its worth being aware of because there is a simple way to ward this problem. The question is, "Is there a relationship between cervical spinal adjusting or thoracic spinal adjustment for that matter and cervical fluid leaks?" The cervical fluid leaks would yield a spontaneous intracranial hypotension, the type of headache that a patient has, for example, after they've had a spinal tap. This whole headache process or this spinal intracranial hypotension was first described in 1938 in Germany. The imaging that we have today gives us a chance to measure these fluids in real-time, see the changes much better. We know this phenomenon now occurs at a rate of about 1 per 50,000 patients. This is twice as common as cervical spine … Excuse me, as vertebral artery dissection in the population. It was later described in couple of years later, as being 1 in 20,000 which would make it five times more common. The average age is in 38-42, female 3:2 versus males and it ranges from children to persons of old age. The key thing I can give you right away to take away from this whole process, "When a patient presents with a positional headache that is when they're laying down the headache goes away. They stand up they get the headache back. That is the classic sign of a dural tear and a cervical spinal fluid leak." When that patient presents to your office, my advice in counsel is refer them for a neurosurgical consideration and a neurosurgical evaluation.
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