1413 - Vertebral Artery Dissection Following Self-Manipulation of Cervical Spine: A Case Report

A 58-year-old man with coronary artery disease, HFrEF, type 2 diabetes, hypertension, prior ischemic stroke, and history of habitual “neck cracking” presented with one week of worsening occipital headache and dizziness. Examination showed intact mental status, cranial nerves, strength, and sensation, with unsteady gait. CT angiography revealed dissection from the left V2 to V4 segment with associated occlusion and subtle left cerebellar hypodensity; brain MRI confirmed a small cerebellar infarct. Echocardiogram showed EF 39% (from 36%) without patent foramen ovale. He received aspirin loading followed by dual antiplatelet therapy (aspirin 81 mg and clopidogrel 75 mg) plus high-intensity statin; permissive hypertension was maintained. Neurology and neurointerventional teams recommended no acute endovascular therapy. PM&R evaluated the patient and coordinated transfer to acute inpatient rehabilitation, where he achieved large functional improvement with marked gains in mobility and activities of daily living.


Discussions:

Vertebral artery dissection is an uncommon but important cause of posterior-circulation stroke. Epidemiologic data support an association between cervical manipulation and dissection, particularly in individuals with vascular risk factors (e.g., hypertension). Early vascular imaging (CTA/MRA) enables timely diagnosis, and antithrombotic therapy for approximately 3–6 months mitigates early recurrence risk. Rehabilitation is integral to functional recovery after posterior strokes. Additionally, counseling to avoid high-velocity neck manipulation and forceful end-range rotation/extension during healing is essential.


Conclusions:

This case underscores the potential risk of vertebral artery dissection with neck manipulation, the importance of prompt imaging and antithrombotic therapy, and the value of coordinated inpatient rehabilitation—resulting here in substantial functional gains.