Delayed vertebral artery dissection after mild trauma in a motor vehicle collision

Vertebral artery dissection can be insidious and is a leading cause of stroke in young patients, second only behind cardioembolic events [1]. We present the case of a 42-year-old patient who presented to the emergency department with diaphoresis and a complaint of neck pain one month after a low speed motor vehicle collision. The patient was transferred to a stroke center where cerebral angiography showed severe vertebral artery stenosis with likelihood of dissection after a noncontrast CT was negative for hemorrhage. She was definitively treated with antiplatelet therapy and discharged to rehab. By reviewing the most recent literature, we better define this illness. Most commonly, patients with arterial dissection present with head or neck pain, stroke, and Horner syndrome. It is now thought that vertebral artery dissection is a multifactorial disease process where certain intrinsic factors are present in the setting of an exacerbating extrinsic factor such as a low speed car accident, direct trauma, heavy lifting, or a rotational sports injury. And while our patient was treated with antiplatelet therapy and intravascular intervention, vertebral artery dissection is rare and further research is required to better guide treatment as there is no definitive data showing superiority of either anticoagulation or antiplatelet pharmaceutics.