Mosby John S, Duray Stephen M
Division of Clinics, Palmer College of Chiropractic, Davenport, IA 52803, USA.
J Chiropr Med. 2011 Dec;10(4):283-7. doi: 10.1016/j.jcm.2011.01.007.
The purpose of this case report is to describe a patient who regularly practiced self-manipulation of her neck who presented with shoulder and neck pain and was undergoing a vertebral artery dissection.
A 42-year-old female patient sought care for left shoulder pain with a secondary complaint of left lower neck pain. Twelve days prior, she had had "the worst headache of her life," which began in her left lower cervical spine and extended to her left temporal region. The pain was sudden and severe, was described as sharp and burning, and lasted 3 hours. She reported nausea, vomiting, and blurred vision.
Initial history and examination suggested that the patient's head and neck pain was not musculoskeletal in origin, but vascular. She repeatedly requested that an adjustment be performed, but instead was referred to the local emergency department for further evaluation. Magnetic resonance angiogram revealed a dissection of the left vertebral artery from C6 to the C2-C3 interspace and a 3-mm dissecting pseudoaneurysm at the C3 level. She underwent stent-assisted percutaneous transluminal angioplasty combined with antiplatelet therapy (clopidogrel) and experienced a good outcome.
This case suggests that careful history taking and awareness of the symptoms of VAD are necessary in cases of sudden head and neck pain. More research is needed on the relationship between vertebral artery dissection and self-manipulation of the neck.
本病例报告旨在描述一名经常自行推拿颈部的患者，该患者出现肩部和颈部疼痛，并发生了椎动脉夹层。
一名42岁女性患者因左肩疼痛就诊，伴有左颈部下段疼痛的次要主诉。12天前，她经历了“一生中最严重的头痛”，始于左颈部下段并延伸至左颞部。疼痛突然且剧烈，被描述为刺痛和灼痛，持续了3小时。她报告有恶心、呕吐和视力模糊的症状。
初步病史和检查表明，患者的头颈部疼痛并非源于肌肉骨骼，而是血管性的。她多次要求进行整脊治疗，但反而被转诊至当地急诊科进行进一步评估。磁共振血管造影显示左椎动脉从C6至C2 - C3间隙夹层，C3水平有一个3毫米的夹层假性动脉瘤。她接受了支架辅助经皮腔内血管成形术并联合抗血小板治疗（氯吡格雷），预后良好。
本病例表明，对于突发头颈部疼痛的病例，仔细询问病史并了解椎动脉夹层的症状是必要的。关于椎动脉夹层与颈部自我推拿之间的关系，还需要更多研究。
