Recognition of Spontaneous Vertebral Artery Dissection Preempting Spinal Manipulative Therapy: A Patient Presenting With Neck Pain and Headache for Chiropractic Care

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SOURCE:   J Chiropr Med. 2014 (Jun);   13 (2):   90-95 ~ FULL TEXT

Ross Mattox, DC, [a], Linda W. Smith, DC, [b] and
Norman W. Kettner, DC, DACBR, FICC [c]

a   Diagnostic Imaging Resident,
Department of Radiology,
Logan University, Chesterfield, MO

b   Chiropractic Physician,
Private Practice, St. Louis, MO

c   Chair, Department of Radiology,
Logan University, Chesterfield, MO

OBJECTIVE:   The purpose of this case report is to describe a patient who presented to a chiropractic physician for evaluation and treatment of neck pain and headache.

CLINICAL FEATURES:   A 45-year-old otherwise healthy female presented for evaluation and treatment of neck pain and headache. Within minutes, non-specific musculoskeletal symptoms progressed to neurological deficits, including limb ataxia and cognitive disturbances. Suspicion was raised for cerebrovascular ischemia and emergent referral was initiated.

INTERVENTION AND OUTCOME:   Paramedics were immediately summoned and the patient was transported to a local hospital with a working diagnosis of acute cerebrovascular ischemia. Multiplanar computed tomographic and magnetic resonance imaging with contrast revealed vertebral artery dissection of the V2 segment in the right vertebral artery. Anticoagulation therapy was administered and the patient was discharged without complications after 5 days in the hospital.

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CONCLUSION:   This case highlights the potential for patients with vertebral artery dissection to present with nonspecific musculoskeletal complaints. Neurological symptoms may not manifest initially, but their sudden onset indicates the possibility of an ischemic cerebrovascular event. We suggest that early recognition and emergent referral for this patient avoided potential exacerbation of an evolving pre-existing condition and resulted in timely anticoagulation treatment.


From the FULL TEXT Article:


The development of vertebral artery dissection (VAD) arises randomly and unpredictably from neck movement and may occur prior to, during, or following spinal manipulative therapy (SMT) regardless of force load or neck position during manipulation. [1] Arterial dissection occurs when blood penetrates a tear in the intimal layer of the artery and a mural hematoma develops within the tunica media. [2] Dissection of the VA is a rare event, with an estimated incidence of 0.97 to 1.12 per 100,000 individuals per year. [3]

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