- 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.
- Case report, review of recent literature.
- A 42-year-old woman reported acute onset:
- Pain in left neck, face.
- No headache, dizziness, vomiting.
- Past medical history:
- Rear-ended in car 1 month prior with whiplash, neck pain.
- 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.