Neuroradiology Case "Vertebral Artery Dissection"
We recently helped a 31 year-old otherwise healthy female who had a “vertebral artery dissection” secondary to chiropractic manipulation of her neck with subsequent strokes. Our neuroradiology experts identified subtle foci of stroke in the occipital cortex explaining her visual symptoms, as well as dissected left vertebral artery. The findings were unequivocal and the case was settled favorably during mediation.
Educational points:
Vertebral artery dissection is a separation of the inner layer of the three-layered wall of the artery supplying oxygenated blood to the posterior part of the brain and spine. It’s usually caused by trauma to the vessel wall, and is seen in setting of motor vehicle accidents, chiropractic neck manipulation, or other traumatic injury to the neck. A de-lamination between the outer and inner walls of a blood vessel occurs and blood accumulates between these layers (“false lumen”). As the false lumen is limited in size and extent it enlarges as blood accumulates and causes compression of the original arterial lumen (“true lumen”), as well as aneurysmal dilatation (enlargement of the caliber) of the entire artery.
Arterial dissection is the most common cause of stroke in young otherwise healthy individuals. The most common and well understood mechanism of stroke as result of arterial dissection is development of blood clots form at the site of the tear in the arterial wall, which break off and travel through the arteries to the brain, eventually blocking the blood supply to a part of the brain, resulting in an ischemia and/or infarct. Another, less common, mechanism by which arterial dissection can lead to a stroke is occlusion of the dissected artery (true lumen) secondary to the mass effect of blood accumulation in the false lumen.