Twists and Turns: A Chiropractic Roller Coaster Experience Unraveling the Intricacies of Bilateral Vertebral Artery Dissection.

ABSTRACT

The primary insult in vertebral artery dissections (VADs) involves a tear in the vertebral artery intima, resulting in potential thrombus formation and an elevated risk of cerebrovascular events, such as stroke. Despite its relatively low overall incidence rate, VADs contribute to a significant proportion of ischemic strokes within the younger population. VAD has been associated with various risk factors including but not limited to neck trauma from chiropractic manipulation and significant neck movements. Our patient initially presented with a worsening occipital headache but was discharged due to the absence of any red-flag symptoms. However, the patient shortly returned to the ED upon worsening symptoms, and despite the lack of apparent neurological deficits, the patient's history of cervical spine manipulation and exposure to neck trauma risk activities (roller coaster riding) increased suspicion for VAD. This case highlights the importance of considering VAD as a differential diagnosis in young patients presenting with unexplained headaches and neck pain following events that exert stress on the vertebral arteries, such as roller coaster rides and chiropractic neck manipulation. When managed properly, the long-term prognosis of VAD is generally favorable; however, the risk of recurrent dissection and stroke still remains. Thus, this case further emphasizes the need for timely intervention and the role of dual anti-platelet therapy (DAPT) in the management of VAD to prevent further complications such as stroke.