Execution
- 1Ask about the 5 D's: dizziness, drop attacks, diplopia, dysarthria, and dysphagia.
- 2Ask about the 3 N's: nausea, numbness, and nystagmus or visual disturbance.
- 3Ask about sudden onset severe headache or neck pain, recent trauma, infection, vascular risk factors, Horner syndrome, and focal neurological symptoms.
- 4Check whether symptoms are new, unusual, progressive, or not clearly linked to mechanical neck movement.
- 5Refer urgently when the pattern suggests cervical arterial dissection, posterior circulation ischemia, or other serious neurological pathology.
Positive outcome
The screen is positive when vascular-pattern symptoms are present, especially sudden severe neck pain or headache with neurological signs, 5 D's or 3 N's, drop attacks, diplopia, dysarthria, dysphagia, limb numbness or weakness, or Horner syndrome. A positive screen is not a physiotherapy diagnosis; it is a referral or emergency escalation trigger. Absence of these symptoms does not guarantee vascular safety.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Rushton et al. (2014) | IFOMPT clinical reasoning framework | NA | NA | NA | NA |
| Rushton et al. (2023) | updated IFOMPT cervical framework | NA | NA | NA | NA |
| Thomas (2016) | cervical arterial dissection overview | NA | NA | NA | NA |
CommentMagee distinguishes cervical arterial dissection features from vertebrobasilar insufficiency and lists the 5 D's pattern in the cervical spine chapter. Modern frameworks prioritize history, risk factors, and neurological reasoning over positional artery tests. Sudden severe headache, focal neurological signs, or progressive symptoms warrant urgent referral.
Low Clinical Value