Vertebral artery dissection can present weeks after minor trauma

  • Am J Emerg Med

  • curated by Jenny Blair, MD
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Vertebral artery dissection (VAD) may not be obvious.
  • Maintain high clinical suspicion amid recent trauma, even trivial.

Why this matters

  • VAD is a major cause of stroke in young people, second only to cardioembolic events.

Description

  • Case report, review of recent literature.

Key details

  • A 42-year-old woman reported acute onset:
    • Pain in left neck, face.
    • Numbness.
    • Diaphoresis.
  • No headache, dizziness, vomiting.
  • Past medical history: 
    • Rear-ended in car 1 month prior with whiplash, neck pain.
  • Exam:
    • Neck: no pain, tenderness, or external abnormalities. 
    • No diaphoresis.
    • Normal cranial nerves II-XII, normal pupils.
    • No nystagmus, focal weakness, sensory deficits.
  • CT angiogram of head and neck: 
    • Left intracranial vertebral artery (VA): stenosis, occlusion.
    • Left posterior internal carotid artery: concerning for VAD.
  • Patient course:
    • Developed dysphagia, diplopia.
    • Underwent left VA embolization for suspected acute dissection. 
    • Imaging: left lateral medullary infarction. 
    • Began rehabilitation for multiple neurological sequelae.
  • Neck (vertebral or internal carotid) artery dissection symptoms: head or neck pain (80%), stroke (67%), Horner syndrome (25%).
  • VAD etiology likely multifactorial, requiring both injury and vulnerability.
  • Association with “trivial” trauma in 1 review: OR, 3.8 (95% CI, 1.3-11).
  • Traumas have included sudden head rotation during sports, working for hours with reclined head, and chiropractic.