BMJ Case Reports 2015; doi:10.1136/bcr-2015-212568

Vertebral artery dissection in evolution found during chiropractic examination

  1. Allison Grayev4
  1. 1Department of Chiropractic Medicine, Group Health Cooperative of South Central Wisconsin, Madison, Wisconsin, USA
  2. 2Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  3. 3Department of Family Medicine, Alpert Medical School of Brown University, Pawtucket, Rhode Island, USA
  4. 4Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  1. Correspondence to Professor Michael J Schneider, mjs5{at}
  • Accepted 8 October 2015
  • Published 12 November 2015


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.

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