Neck pain and minor trauma: normal radiographs do not always exclude serious pathology.
A 37-year-old woman presented following a trampolining accident with neck pain and paraesthesia of the left arm. Cervical spine radiographs were normal and a provisional diagnosis of whiplash was made. Three hours later she developed rotational vertigo and then cerebellar signs. Magnetic resonance angiography and magnetic resonance imaging of the brain confirmed the diagnosis of vertebral artery dissection (VAD) with cerebellar embolic infarcts. She was anticoagulated and symptoms resolved over one week. VAD is a relatively common cause of posterior circulation stroke in young people. It usually presents following (often minor) trauma, with headache, neck pain, cerebellar, sensory and cranial nerve signs. However, it remains a diagnosis that is frequently missed or misdiagnosed.
Ribbons
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Accident and Emergency Department, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, UK. tamsinribbons@doctors.org.uk
Bell
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D000328:Adult; D001265:Athletic Injuries / Q000000981:diagnostic imaging* / Q000209:etiology; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D004630:Emergencies; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D019838:Neck Injuries / Q000000981:diagnostic imaging* / Q000209:etiology; D019547:Neck Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D010292:Paresthesia / Q000209:etiology; D011859:Radiography