Endovascular Treatment of Basilar Artery Thrombosis Secondary to Bilateral Vertebral Artery Dissection with Symptom Onset Following Cervical Spine Manipulation Therapy
Challenging differential diagnosis, Management of emergency care, Rare disease
Ronni Mikkelsen, Rikke Beese Dalby, Niels Hjort, Claus Ziegler Simonsen, Sanja Karabegovic
Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
Am J Case Rep 2015; 16:868-871
Vertebral artery (VA) dissection (VAD) has been described following neck injury and can be associated with stroke, but the causal association with cervical spine manipulation therapy (cSMT) is controversial. The standard treatment for VAD is antithrombotic medical therapy. To highlight the considerations of an endovascular approach to VAD, we present a critical case of bilateral VAD causing embolic occlusion of the basilar artery (BA) in a patient with symptom debut following cSMT.
CASE REPORT: A 37-year-old woman presented with acute onset of neurological symptoms immediately following cSMT in a chiropractic facility. Acute magnetic resonance imaging (MRI) showed ischemic lesions in the right cerebellar hemisphere and occlusion of the cranial part of the BA. Angiography depicted bilateral VAD. Symptoms remitted after endovascular therapy, which included dilatation of the left VA and extraction of thrombus from the BA. After 6 months, the patient had minor sensory and cognitive deficits.
CONCLUSIONS: In severe cases, VAD may be complicated by BA thrombosis, and this case highlights the importance of a fast diagnostic approach and advanced intravascular procedure to obtain good long-term neurological outcome. Furthermore, this case underlines the need to suspect VAD in patients presenting with neurological symptoms following cSMT.
Keywords: Cerebral Angiography, Basilar Artery, Adult, Cervical Vertebrae, Endovascular Procedures - methods, Intracranial Thrombosis - surgery, Magnetic Resonance Angiography, Magnetic Resonance Imaging, Musculoskeletal Manipulations - adverse effects, Vertebral Artery Dissection - surgery