title: Recognition of spontaneous vertebral artery dissection preempting spinal manipulative therapy: a patient presenting with neck pain and headache for chiropractic care.
abstract: OBJECTIVE
  The purpose of this case report is to describe a patient who presented to a chiropractic physician for evaluation and treatment of neck pain and headache.
  
  
  METHODS
  A 45-year-old otherwise healthy female presented for evaluation and treatment of neck pain and headache. Within minutes, non-specific musculoskeletal symptoms progressed to neurological deficits, including limb ataxia and cognitive disturbances. Suspicion was raised for cerebrovascular ischemia and emergent referral was initiated.
  
  
  RESULTS
  Paramedics were immediately summoned and the patient was transported to a local hospital with a working diagnosis of acute cerebrovascular ischemia. Multiplanar computed tomographic and magnetic resonance imaging with contrast revealed vertebral artery dissection of the V2 segment in the right vertebral artery. Anticoagulation therapy was administered and the patient was discharged without complications after 5 days in the hospital.
  
  
  CONCLUSIONS
  This case highlights the potential for patients with vertebral artery dissection to present with nonspecific musculoskeletal complaints. Neurological symptoms may not manifest initially, but their sudden onset indicates the possibility of an ischemic cerebrovascular event. We suggest that early recognition and emergent referral for this patient avoided potential exacerbation of an evolving pre-existing condition and resulted in timely anticoagulation treatment.
authors: Diagnostic Imaging Resident, Department of Radiology, Logan University, Chesterfield, MO.
authors: Ross
authors: R
authors: Mattox
authors: Chiropractic Physician, Private Practice, St. Louis, MO.
authors: Linda W
authors: LW
authors: Smith
authors: Chair, Department of Radiology, Logan University, Chesterfield, MO.
authors: Norman W
authors: NW
authors: Kettner
keywords: Chiropractic; Manipulation; Spinal; Stroke; Vertebral artery dissection