Talk:Vertebral artery dissection

Notable cases

Is it really a good idea to turn this medical article into a place for "Notable cases"? This is all sourced to popular press coverage. Where does this stop? I see this type of material as very relevant in each individual's biography, but not here. What are your thoughts? -- Brangifer (talk) 03:59, 28 November 2014 (UTC)

I think your suggestion is a good one.... they belong in the biography (if there is one). Regards, Ariconte (talk) 04:37, 28 November 2014 (UTC) .... I removed the section, hopefully not upsetting anyone too much.... can be reverted and discussed some more if wanted. Regards, Ariconte (talk) 04:46, 28 November 2014 (UTC)

Sometimes a few cases are notable such as that of Lou Gehrig and ALS. MEDRS compliant sources are not needed when documenting who had what disease. I am okay with the popular press for this. I think we should however keep the bar fairly high for inclusion Doc James (talk · contribs · email) 05:01, 28 November 2014 (UTC)

I agree that MEDRS isn't always necessary for this type of thing. My concern is that this section could become a dumping ground and include cases which don't really build any knowledge of the subject. Lou Gehrig and ALS are intimately tied together in the USA, so a mention there is quite logical.

I think we need some type of logical connection here. Just the event or mention of a notable person getting a VAD isn't significant enough for mention here. Also the case of cricket batsman Phillip Hughes can confuse people, as it says something about only 100 cases. That is very confusing. VAD is relatively rare, but much more common than that, but it's uncommon for it to lead to a "subsequent subarachnoid bleed". It more commonly leads to blood clots, which, because they form over days, can later (sometimes over a month later) suddenly loosen and travel directly to the brain, causing a stroke. In Canada the risk of stroke was rated at 500% following cervical manipulation, and in California it was 600% increased risk, all compared to figures from strokes not associated with any cervical manipulation. User:Doc James and User:Jfdwolff can correct me if I'm wrong.

My point is, we shouldn't include any case which can be misleading, simplistic, or not serve any special purpose in explaining the nature of VAD or increasing knowledge of VAD. I'm open for including special cases which serve these needs. -- Brangifer (talk) 06:24, 28 November 2014 (UTC)

I often give way to these sections simply as an effort to stop people from continually adding this content to the wrong spot. Doc James (talk · contribs · email) 09:15, 28 November 2014 (UTC)

I support "Notable cases" sections if there is some evidence that a famous person's case has led to a widespread awareness of a condition (e.g. as with Lou Gehrig, and Michael J Fox and premature Parkinson's disease). While it is quite early to judge, I think there is sufficient news coverable to support the inclusion of Hughes' case.

Unfortunately I have never been able to find a good source for the reasonably well known case of Andrew Lansley (UK politician) who had a cerebellar infarct after sustaining VAD playing sports.

Perhaps we need to talk about more stringent criteria on WT:MEDMOS. Again. JFW | T@lk 12:16, 28 November 2014 (UTC)

Sounds good. BTW, has any information been released from x-rays, CTs, or MRIs about whether the blow caused a fracture of the upper cervical vertebrae, or was the blow strong enough to simply amount to a powerful "spinal adjustment"? I'm interested in the sequence of symptoms he developed. -- Brangifer (talk) 15:30, 28 November 2014 (UTC)

CADISS

I missed this result, but it contributes little. doi:10.1212/WNL.0b013e318264e36b JFW | T@lk 08:11, 15 May 2015 (UTC)

Intracranial dissection

Review by basically everyone who has some authority in this subject: doi:10.1016/S1474-4422(15)00009-5 JFW | T@lk 14:22, 20 May 2015 (UTC)

Whiplash

This "Whiplash has been studied as a major contributor to VAD" is based on a primary source of 8 cases and adds little to what is already in the article. Thus moved here for discussion. Doc James (talk · contribs · email) 23:03, 25 July 2015 (UTC)

A secondary source was added, but I have tweaked it a bit because it was used to attribute unrelated content. JFW | T@lk 20:24, 26 July 2015 (UTC)

Please search the following phrase

…and consider if the statement is accurate or not. Is use of the word "predispose" here standard, and best practice? Predispose in ordinary language means to make susceptible. Is this correct here — that having migraines or an aortic root aneurism makes people susceptible? I.e., is it indeed the case, that a longitudinal study was done of migraine and aortic aneurism groups, and in these groups, a higher than control group number of VADs were found later to have accrued?

* "Presence of an aneurysm of the aortic root and a history of migraine may predispose to vertebral artery dissection."

Otherwise, apart from such a study, I think the best that can be said is "correlated", even if at some point the single review might have said predisposed. (This seems to be either a misstatement what the literature cited states, or perhaps a poor construction in that source.)

Moreover, relative to other possible language possible, use of "predispose" seems, overly much, to imply "causality." I could imagine various underlying (genetic, traumatic) causes giving rise to all three, but would like to see citation of evidence that the migraine or the aneurism has a causal connection to the VAD.

Cheers, leave it your capable (medical) hands. Le Prof 71.201.62.200 (talk) 04:31, 20 August 2015 (UTC)

Removal of recent, reliable, secondary source

This revert just deleted a secondary source from 2016 [1]. The explanation for the revert was that "Cureus is a new and open access source". I do not see any Wikipedia policy that suggests that new journals, or open-access journals are not reliable. The journal is peer-reviewed, has an editorial board of medical doctors and scientists and is indexed in Medline and the review was written by medical doctors. There is no impact factor yet as Cureus is indeed new, but again, I see no policy that rejects a mainstream medical source based on impact factor. Perhaps most importantly, the conclusions of the new systematic review in Cureus are consistent with the previously most recent secondary source on the topic [2] and is not being used to make any new or bold claims, it just summarized what is already known. At this point, there are zero secondary sources published in the past 5 years that are suggesting a causational relationship, yet we keep this idea of causation in the article as noteworthy based on a 6 year old primary source by Ernst? I would suggest that if an older (>5 years) primary source from Ernst is ok to use here to suggest causation (when all other current sources suggest this is a reach) so is a brand new secondary source written by medical researchers/neurosurgeons that suggests otherwise and is consistent with all other recent sources. 2001:56A:75B7:9B00:F155:3651:86CD:A6E4 (talk) 17:06, 25 May 2016 (UTC)

I started a discussion at project medicine page for comments about the reliability of Cureus. [3] 2001:56A:75B7:9B00:F155:3651:86CD:A6E4 (talk) 17:23, 25 May 2016 (UTC)

Journal has no impact factor per http://cofactorscience.com/blog/journal/cureus so agree it is not sufficient. Doc James (talk · contribs · email) 07:45, 26 May 2016 (UTC)

2001, can I encourage you to get a proper account so we can ping you with messages on this talk page?

I think Cureus is currently inadequate when held against the standards outlined in WP:MEDRS. I think the Haynes review (doi:10.1111/j.1742-1241.2012.03004.x) is very well balanced and I don't really see an advantage in replacing it with the review in Cureus. JFW | T@lk 09:11, 26 May 2016 (UTC)

Thank you for your replies!

Doc James, if impact factor is a policy-based criteria for exclusion, then I accept that. However, I know that among academics, impact factor is a ever-more controversial way to assess quality (http://jcb.rupress.org/content/201/5/651.full). Moreover, I cannot find the relevant policy; could you point it out?

Jfdwolff, based on your comment, I am concerned that you did not really examine my edit before you reverted it. I did not use the new secondary source from Cureus to replace Haynes et al 2014, I used it to replace the 2009 article from Guzman. If you take another look, I made 3 notable changes with my edit:

1) Replaced Guzman et al 2009 with Church et al 2016. Both sources describe the evidence-based hypothesis that patients are presenting with a stroke in progress to their medical doctors and chiropractors (IE: epidemiological data show similar risk of VAD for visits to each professional). However, Church is more recent, includes the use of Hill's criteria for causation to support their assertion, and includes some new primary studies that were not included in Guzman et al 2009. Do you really think Church et al 2016 is unacceptable to replace Guzman et al 2009? I think we could at least include both sources?

2) Removed the specific details about the main alternate hypothesis (stroke already in progress) and replaced it with a more generic mention that there are hypotheses other than the 'causation hypothesis'.

3) Removed the incorrect suggestion that only chiropractic proponents question the causational relationship. Both the Guzman et al 2009 article (currently used in the article) and the new Cureus source are written by medical doctors and they question the 'causation hypothesis'. As such, it is incorrect (non-neutral POV) to suggest that it is only chiropractors who are asking these questions.2001:56A:75B7:9B00:4525:C63F:8995:A572 (talk) 20:22, 26 May 2016 (UTC)

• I have tried again, this time I kept all the original sourcing and just added the new review. Also removed non-neutral POV text (as discussed in point #3 above). Thoughts based on above comments and new change? 2001:56A:75B7:9B00:4525:C63F:8995:A572 (talk) 20:35, 26 May 2016 (UTC)

Our criteria is "reputable medical journal". If the impact factor of a journal is zero it is a marker that it likely has not been around long enough to get a reputation as reliable. Doc James (talk · contribs · email) 03:53, 27 May 2016 (UTC)

So I understand then that there is no specific policy regarding impact factor; it is just how you are interpreting policy. I have seen blog posts included as sources on medical articles (eg: science-based medicine); there only ever seems to be a concern with including lower quality sources when they are making controversial claims, or if they are being used to contradict more reliable sources. The Cureus source is a good-quality source according to MEDRS (secondary source, Medline indexed, peer-reviewed), it represents an update in the literature, and it makes no bold claims outside of what is already accepted based on other sources. I honestly cannot see the rationale for strictly excluding the source from the article based on the impact factor. 2001:56A:75B7:9B00:4525:C63F:8995:A572 (talk) 04:25, 27 May 2016 (UTC)

The current content is NPOV and well sourced. Jytdog (talk) 04:29, 27 May 2016 (UTC)

Will including the Cureus source alongside the existing Guzman source diminish the article, or the reader's experience in any way? I can certainly see a few ways of how having additional open-access source available that compliments the existing sources might benefit the reader.2001:56A:75B7:9B00:4525:C63F:8995:A572 (talk) 04:44, 27 May 2016 (UTC)

Yes we actually want people to go look at the source. If we consider it unreliable we don't want to refer people to it. Jytdog (talk) 04:57, 27 May 2016 (UTC)

But that there is the rub; the Cureus source has not been found to be unreliable. The criticism is that it's IF is too low (zero). But MEDRS policy does not list IF as a strict criteria for exclusion (it does list many other characteristics that we are ignoring here though). Were the new source a blog, I would have no argument. Were it a news article, no argument. Were it a primary source, no argument. Were it to contradict 'better' sources, no argument. Were it to be authored by those with COI, no argument. However, it fits none of these 'unreliability criteria'. The only criticism is IF of the journal? 2001:56A:75B7:9B00:4525:C63F:8995:A572 (talk) 05:06, 27 May 2016 (UTC)

Big thumbs down at WT:MED. I thought you didn't care that much. Jytdog (talk) 05:12, 27 May 2016 (UTC)

Jytdog, you have chosen not to address any of the MEDRS policy-based concerns I raised above? Instead, you felt the need to be a dick with a comment like "I thought you didn't care that much". Do you understand that we are having 2 separate conversations at this talk page? Did you notice I started a new thread below regarding your edits to the text (that was not related to the Cureus source) and that was where I stated that I "did not care that much". I notice that you also recently placed a really asinine comment towards WAID at WP:MED and then quickly removed it; is this your normal editing/discussion style? Can you focus on improving the article and save your uncivil commentary for another discussion where editors feel like being uncivil towards one another?2001:56A:75B7:9B00:441:A41B:9784:50F1 (talk) 05:28, 27 May 2016 (UTC)

Recent edits

Jytdog, I think that adding the quote was a good idea with this edit, however, I am more partial to the wording I used over your wording for the text. I prefer "has been suggested" rather than "may be", but this may just be my personal academic writing style moreso than what is actually correct. Just commenting with my thoughts. 2001:56A:75B7:9B00:4525:C63F:8995:A572 (talk) 04:48, 27 May 2016 (UTC)

It is best to use the active voice in encyclopedia writing; using the passive voice just invites "says who"? Jytdog (talk) 04:56, 27 May 2016 (UTC)

No problem, it is not that important to me, I guess it is just my own stylistic preference. I would suggest that the answer to 'says who?' is 'the source provided'.2001:56A:75B7:9B00:4525:C63F:8995:A572 (talk) 05:00, 27 May 2016 (UTC)