Chiropractor Identifies Dissection in Process
- Neck pain and headache are common complaints that respond well to chiropractic cervical manipulation.
- Cervical manipulation has recently been blamed as a causative factor in vertebral artery dissections.
- Vertebral artery dissection in process primarily presents as neck pain and headache.
- Recent research suggests that cervical manipulation does not cause vertebral artery dissections but that patients with dissections in process enter with neck pain and headache and the dissection is overlooked.
- This article reports on a patient entering for manipulation with vertebral dissection in process. This article challenges chiropractic physicians to consider dissection as a possible diagnosis for patients entering with neck pain and headache.
A 30-year-old woman presented to an emergency department with sudden onset of transient loss of left peripheral vision. Owing to a history of migraine headaches, she was released with a diagnosis of ocular migraine. Two days later, she sought chiropractic care for the chief symptom of severe neck pain. The chiropractor suspected the possibility of vertebral artery dissection (VAD). No manipulation was performed; instead, MR angiography (MRA) of the neck was obtained, which revealed an acute left VAD with early thrombus formation. The patient was placed on aspirin therapy. Repeat MRA of the neck 3 months later revealed resolution of the thrombus, without progression to stroke. This case illustrates the importance for all healthcare providers who see patients with neck pain and headache to be attentive to the symptomatic presentation of possible VAD in progress.
Futch D, Schneider MJ, Murphy D, Grayev A. Vertebral artery dissection in evolution found during chiropractic examination. BMJ Case Rep. 2015 Nov 12;2015. pii: bcr2015212568. doi: 10.1136/bcr-2015-212568.