Recognition of Vertebral Artery Dissection in a High-Risk Postpartum Patient by a Chiropractic Physician

We report a case of vertebral artery dissection (VAD) in a patient with postpartum preeclampsia and underscore the contribution of chiropractic assessment in recognizing vascular pathology, facilitating neurovascular imaging, and expediting emergency intervention. A 36-year-old woman with a history of mixed connective tissue disease presented to the emergency department five days postpartum with facial and peripheral edema, recent onset of hypertension, acute severe neck pain, headache, lightheadedness, confusion, and gait instability. Magnetic resonance angiography (MRA) and magnetic resonance venography of the head were performed. Small, unruptured bilateral internal carotid artery aneurysms were visualized. The patient was admitted and treated for postpartum preeclampsia. Upon discharge, she followed up with a neuroendovascular specialist. Although the patient improved with preeclampsia management, concerning neurologic symptoms persisted. The patient later consulted a chiropractor, who suspected VAD. Emergent neck MRA was recommended and performed, confirming VAD 12 days after the initial emergency department visit. The patient was initiated on antithrombotic therapy, with subsequent resolution of symptoms and no evidence of ischemic stroke. This case underscores the importance of maintaining a high index of suspicion for VAD in postpartum patients presenting with new-onset neurological symptoms, particularly in the context of hypertensive disorders of pregnancy and underlying connective tissue disease. It further illustrates the potential role of chiropractic evaluation in the early clinical recognition of vascular pathology, which may facilitate timely diagnosis and intervention, and reduce the risk of stroke.