Futch Dan, Schneider Michael J, Murphy Donald, Grayev Allison
Department of Chiropractic Medicine, Group Health Cooperative of South Central Wisconsin, Madison, Wisconsin, USA.
Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
BMJ Case Rep. 2015 Nov 12;2015:bcr2015212568. doi: 10.1136/bcr-2015-212568.
A 30-year-old woman presented to an emergency department with sudden onset of transient loss of left peripheral vision. Owing to a history of migraine headaches, she was released with a diagnosis of ocular migraine. Two days later, she sought chiropractic care for the chief symptom of severe neck pain. The chiropractor suspected the possibility of vertebral artery dissection (VAD). No manipulation was performed; instead, MR angiography (MRA) of the neck was obtained, which revealed an acute left VAD with early thrombus formation. The patient was placed on aspirin therapy. Repeat MRA of the neck 3 months later revealed resolution of the thrombus, without progression to stroke. This case illustrates the importance for all healthcare providers who see patients with neck pain and headache to be attentive to the symptomatic presentation of possible VAD in progress.
一名30岁女性因突发左侧周边视野短暂丧失就诊于急诊科。由于有偏头痛病史，她被诊断为眼性偏头痛后出院。两天后，她因严重颈部疼痛的主要症状寻求脊椎按摩治疗。脊椎按摩师怀疑有椎动脉夹层（VAD）的可能性。未进行手法治疗；而是进行了颈部磁共振血管造影（MRA），结果显示急性左侧VAD并伴有早期血栓形成。患者接受了阿司匹林治疗。3个月后重复进行颈部MRA显示血栓溶解，未进展为中风。该病例说明了所有诊治颈部疼痛和头痛患者的医疗服务提供者注意可能正在发生的VAD症状表现的重要性。
