Neck pain patient with a final diagnosis of bilateral vertebral artery tears: A case report

The purpose of this case report is to present atypical red flags for vertebral artery tears in a young adult with neck pain.

A 24-year-old female patient presented with acute neck pain 4 days after waterskiing. Pain extended from the suboccipital muscles to the cervicothoracic junction. She had visual disturbances described as "fans" in the peripheral vision bilaterally. Orthopedic and neurological examination was unremarkable except for the inability to reproduce the symptoms and a guarded range of motion.

Initial chiropractic treatment consisted of gentle manual soft-tissue massage and Kinesio Tape, both over the cervicothoracic junction, and a referral for medical evaluation. Four days later, the patient went to the emergency department, where a computed tomography scan was performed and revealed a tear in the vertebral artery at C3/C4 on the left and C4/C5 on the right. Anticoagulants were administered, and referral to a specialty clinic, where another computed tomography scan was performed to confirm the diagnosis. The specialty clinic prescribed Plavix for 6 months and aspirin for life.

This case report emphasizes that not all patients with vertebral artery tears present with classic stroke symptoms. Using this clinically recommended risk-benefit assessment strategy may help mitigate risk related to the broad differential diagnosis of neck pain.