Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature.
Cervical spine manipulation
Osteopathy
Pregnancy
Vertebral artery dissection
Vertebrobasilar ischemia
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
20 Oct 2021
20 Oct 2021
Historique:
received:
08
02
2021
accepted:
02
09
2021
entrez:
21
10
2021
pubmed:
22
10
2021
medline:
27
10
2021
Statut:
epublish
Résumé
Vertebral artery dissection is an uncommon, but potentially fatal, vascular event. This case aimed to describe the pathogenesis and clinical presentation of vertebral artery dissection in a term pregnant patient. Moreover, we focused on the differential diagnosis, reviewing the available evidence. A 39-year-old Caucasian woman presented at 38 + 4 weeks of gestation with a short-term history of vertigo, nausea, and vomiting. Symptoms appeared a few days after cervical spine manipulation by an osteopathic specialist. Urgent magnetic resonance imaging of the head was obtained and revealed an ischemic lesion of the right posterolateral portion of the brain bulb. A subsequent computed tomography angiographic scan of the head and neck showed a right vertebral artery dissection. Based on the correlation of the neurological manifestations and imaging findings, a diagnosis of vertebral artery dissection was established. The patient started low-dose acetylsalicylic acid and prophylactic enoxaparin following an urgent cesarean section. Vertebral artery dissection is a rare but potential cause of neurologic impairments in pregnancy and during the postpartum period. It should be considered in the differential diagnosis for women who present with headache and/or vertigo. Women with a history of migraines, hypertension, or autoimmune disorders in pregnancy are at higher risk, as well as following cervical spine manipulations. Prompt diagnosis and management of vertebral artery dissection are essential to ensure favorable outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Vertebral artery dissection is an uncommon, but potentially fatal, vascular event. This case aimed to describe the pathogenesis and clinical presentation of vertebral artery dissection in a term pregnant patient. Moreover, we focused on the differential diagnosis, reviewing the available evidence.
CASE PRESENTATION
METHODS
A 39-year-old Caucasian woman presented at 38 + 4 weeks of gestation with a short-term history of vertigo, nausea, and vomiting. Symptoms appeared a few days after cervical spine manipulation by an osteopathic specialist. Urgent magnetic resonance imaging of the head was obtained and revealed an ischemic lesion of the right posterolateral portion of the brain bulb. A subsequent computed tomography angiographic scan of the head and neck showed a right vertebral artery dissection. Based on the correlation of the neurological manifestations and imaging findings, a diagnosis of vertebral artery dissection was established. The patient started low-dose acetylsalicylic acid and prophylactic enoxaparin following an urgent cesarean section.
CONCLUSION
CONCLUSIONS
Vertebral artery dissection is a rare but potential cause of neurologic impairments in pregnancy and during the postpartum period. It should be considered in the differential diagnosis for women who present with headache and/or vertigo. Women with a history of migraines, hypertension, or autoimmune disorders in pregnancy are at higher risk, as well as following cervical spine manipulations. Prompt diagnosis and management of vertebral artery dissection are essential to ensure favorable outcomes.
Identifiants
pubmed: 34670622
doi: 10.1186/s13256-021-03090-z
pii: 10.1186/s13256-021-03090-z
pmc: PMC8527659
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
530Informations de copyright
© 2021. The Author(s).
Références
BMC Pregnancy Childbirth. 2016 Jul 16;16(1):164
pubmed: 27422677
Ann Neurol. 2020 Sep;88(3):596-602
pubmed: 32525238
BMJ Case Rep. 2015 Nov 24;2015:
pubmed: 26604230
Obstet Gynecol. 2012 Feb;119(2 Pt 2):489-492
pubmed: 22270449
J Manipulative Physiol Ther. 2009 Feb;32(2 Suppl):S201-8
pubmed: 19251066
Eur J Neurol. 2015 Apr;22(4):736-9
pubmed: 25444227
J Manipulative Physiol Ther. 2005 Oct;28(8):617-22
pubmed: 16226631
World Neurosurg. 2019 Jan;121:83-87
pubmed: 30315974
BMJ. 2012 Jun 07;344:e3679
pubmed: 22677796
Headache. 2011 May;51(5):809-13
pubmed: 21457234
Obstet Gynecol. 2014 Apr;123(4):848-56
pubmed: 24785614
Ann Readapt Med Phys. 2008 Jun;51(5):403-14
pubmed: 18586346
Chiropr Man Therap. 2012 Dec 19;20(1):38
pubmed: 23254252
J Clin Neurosci. 2008 May;15(5):489-94
pubmed: 18343117
Chiropr Man Therap. 2012 Mar 28;20:8
pubmed: 22455720
J Invasive Cardiol. 2010 Dec;22(12):E229-32
pubmed: 21127377
Eur Heart J. 2020 Nov 21;41(44):4234-4242
pubmed: 32728725
Man Ther. 2011 Aug;16(4):351-6
pubmed: 21256072
Stroke Res Treat. 2010;2010:
pubmed: 20700423
Cureus. 2016 Feb 16;8(2):e498
pubmed: 27014532
Cerebrovasc Dis. 2020;49(5):509-515
pubmed: 32980848
J Neurol. 1999 Aug;246(8):712-5
pubmed: 10460450
Obstet Gynecol. 2015 Jan;125(1):124-131
pubmed: 25560114
Cephalalgia. 2011 Jun;31(8):886-96
pubmed: 21511950
BMJ. 2012 Jun 07;344:e3680
pubmed: 22677797
Ann Med. 2019 Mar;51(2):118-127
pubmed: 30889367
Neurologist. 2012 Sep;18(5):245-54
pubmed: 22931728
BMC Pregnancy Childbirth. 2012 Nov 02;12:122
pubmed: 23121892
Neurologist. 2012 May;18(3):149-51
pubmed: 22549357
Thromb J. 2020 Oct 29;18(1):30
pubmed: 33292273