What is Vertebral Artery Dissection?

A vertebral artery dissection is a rare but serious condition where a tear occurs in the inner lining (intima) of one of the vertebral arteries. These arteries run along the spine and supply blood to the brainstem and the back of the brain. When a tear happens, blood can seep into the wall of the artery, causing a clot or stenosis that may restrict blood flow or lead to a stroke. This condition is a leading cause of stroke in young and middle-aged adults.

Common Causes and Risk Factors

The causes of VAD can be spontaneous or related to trauma. Key factors include:

• Neck trauma from accidents, falls, or sudden twisting movements.
• Chiropractic manipulation or other forceful neck adjustments.
• Connective tissue disorders such as Ehlers-Danlos syndrome or Marfan syndrome.
• Infections that weaken arterial walls.
• Strenuous physical activities like weightlifting or vigorous coughing.

Signs and Symptoms

Symptoms can develop suddenly or gradually. The most common signs include:

• Severe, sudden-onset headache, often described as the "worst headache of my life."
• Neck pain on one side, sometimes radiating to the ear or shoulder.
• Dizziness or vertigo, especially when turning the head.
• Blurred or double vision.
• Difficulty speaking (slurred speech) or swallowing.
• Numbness or weakness on one side of the body.
• Loss of coordination or unsteady gait.

Diagnosis

Prompt diagnosis is critical. Physicians typically use:

• MRI (Magnetic Resonance Imaging) and MRA to visualize the arteries.
• CT angiography to detect dissection and blood clots.
• Ultrasound of the neck vessels (Doppler).

Treatment Options

The primary goal is to prevent a stroke. Treatment may include:

• Anticoagulant or antiplatelet medications (e.g., aspirin, warfarin) to reduce clot formation.
• Blood pressure management to lower stress on the artery.
• In severe cases, stenting or surgery to repair the artery.

Prognosis and Recovery

Many people recover fully with early detection and treatment. However, complications such as stroke can be life-altering. Recurrence is rare but possible, especially in those with underlying connective tissue disorders. Rehabilitation may include physical therapy, speech therapy, and lifestyle adjustments.