Investigation of extracranial internal carotid and vertebral artery dissection after cervical spine manipulation

Ji, Bin; Wang, Panying; Huang, Yeqian; Liu, Yinghua

doi:10.1016/j.avsurg.2023.100169

Cited by 2 publications

(1 citation statement)

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“…However, other studies have shown that the V1 segment of the vertebral artery is also susceptible to dissection because it does not course through the transverse foramina and lacks tethering [ 13 ]. Similarly, in CSM-induced VADs, the V3 segment is also commonly affected [ 14 ]. In this patient's EVAD, the dissection was found at the C1 loop of the V3 segment of the vertebral artery, further demonstrating that increased mobility in the V3 segment increases the risk for VAD in the setting of acute CSM.…”

Section: Discussionmentioning

confidence: 99%

Vertebral Artery Dissection in a Young Adult: A Case Report

Toluie,

Joseph,

Hrehorovich

2024

Cureus

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Vertebral artery dissections (VAD) pose a significant risk for strokes, particularly in young adults. This case report details the presentation and management of a 48-year-old patient who was diagnosed with an extracranial VAD following cervical spine manipulation (CSM). The patient's symptoms included acute right-sided ataxia, giddiness, vertigo, nausea, vomiting, and persistent pain behind the right ear, prompting immediate evaluation. After ruling out acute intracerebral hemorrhages, a computed tomography angiogram (CTA) of the head and neck identified a severe narrowing of the right distal vertebral artery with a string sign at the level of the right C1 loop (V3 segment), indicating an extracranial VAD. This finding was further supported when ultrasound (US) imaging revealed a high resistance flow pattern in the right distal vertebral artery. Furthermore, T2 and diffusion-weighted magnetic resonance imaging (MRI) confirmed a 1.8 cm VAD/hematoma and a 1.4 cm acute/subacute infarct in the right posterior inferior cerebellar artery (PICA) territory. This research accentuates the importance of recognizing and addressing that neck pain can be a symptom of musculoskeletal dysfunction or could have neurovascular origins. In this case, the patient's neck pain may have been musculoskeletal or could have been due to a previous dissection. Thus, differentiation should be considered before cervical spine manipulation.

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Section: Discussionmentioning

confidence: 99%