From the Guidelines
Vertebral artery dissection high-risk features include sudden onset severe headache or neck pain, especially following neck manipulation or trauma, along with neurological symptoms such as dizziness, vertigo, visual disturbances, and posterior circulation stroke symptoms. These high-risk features are important to recognize because vertebral artery dissection can lead to serious complications including stroke, permanent neurological deficits, or death if not promptly diagnosed and treated 1.
Key High-Risk Features
- Sudden onset severe headache or neck pain
- Recent neck manipulation or trauma
- Neurological symptoms such as dizziness, vertigo, visual disturbances, and posterior circulation stroke symptoms
- Connective tissue disorders like Ehlers-Danlos syndrome, Marfan syndrome, or fibromuscular dysplasia
- Young age (typically under 45)
- Recent chiropractic manipulation, whiplash injury, or activities involving sudden neck movements
- Bilateral dissections, extension of dissection intracranially, and presence of pseudoaneurysm formation
Diagnostic Approach
If vertebral artery dissection is suspected, immediate neuroimaging with CTA, MRA, or conventional angiography is essential 1.
Treatment Approach
Treatment typically involves anticoagulation with heparin followed by warfarin or antiplatelet therapy with aspirin or clopidogrel for 3-6 months 1. The underlying mechanism involves a tear in the arterial wall creating a false lumen or intramural hematoma that can restrict blood flow or serve as a source of emboli 1. It is crucial to recognize these high-risk features and promptly diagnose and treat vertebral artery dissection to prevent serious complications.
From the Research
High-Risk Features of Vertebral Artery Dissection (VAD)
The high-risk features of VAD include:
- Underlying weakness of the arterial wall, which may be temporary or due to connective tissue disorders such as Ehlers-Danlos syndrome or fibromuscular dysplasia 2
- Minor injuries or trauma, which can trigger dissection in individuals with underlying arterial weakness 3, 4
- Spontaneous dissection, which can occur without any apparent trauma or underlying condition 5, 6
- Presence of connective tissue diseases, which can increase the risk of recurrent dissection 3, 2
- History of indirect neck trauma, such as minor falls or neck torsion, which can cause dissection 4
Clinical Presentation
The clinical presentation of VAD can be nonspecific, with symptoms including:
- Head/neck pain, which is the most common symptom 6
- Dizziness/vertigo, which is present in approximately 58% of cases 6
- Headache, which is present in approximately 51% of cases 6
- Neck pain, which is present in approximately 46% of cases 6
- Stroke, which is a common complication of VAD, especially with extracranial dissections 6
- Transient ischemic attack and subarachnoid hemorrhage, which are less common complications of VAD 6
Diagnostic Challenges
The diagnosis of VAD can be challenging due to the nonspecific nature of the symptoms and the lack of obvious trauma in many cases 5, 6. Imaging studies such as MRI, CT, or ultrasound may be necessary to confirm the diagnosis 3.