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Open Access 01-12-2021 | Migraine | Case report

Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature

Authors: Francesca Monari, Stefano Busani, Maria Giovanna Imbrogno, Isabella Neri, Massimo Girardis, Annamaria Ghirardini, Francesca Cavalleri, Fabio Facchinetti

Published in: Journal of Medical Case Reports | Issue 1/2021

Abstract

Background

Vertebral artery dissection is an uncommon, but potentially fatal, vascular event. This case aimed to describe the pathogenesis and clinical presentation of vertebral artery dissection in a term pregnant patient. Moreover, we focused on the differential diagnosis, reviewing the available evidence.

Case presentation

A 39-year-old Caucasian woman presented at 38 + 4 weeks of gestation with a short-term history of vertigo, nausea, and vomiting. Symptoms appeared a few days after cervical spine manipulation by an osteopathic specialist. Urgent magnetic resonance imaging of the head was obtained and revealed an ischemic lesion of the right posterolateral portion of the brain bulb. A subsequent computed tomography angiographic scan of the head and neck showed a right vertebral artery dissection. Based on the correlation of the neurological manifestations and imaging findings, a diagnosis of vertebral artery dissection was established. The patient started low-dose acetylsalicylic acid and prophylactic enoxaparin following an urgent cesarean section.

Conclusion

Vertebral artery dissection is a rare but potential cause of neurologic impairments in pregnancy and during the postpartum period. It should be considered in the differential diagnosis for women who present with headache and/or vertigo. Women with a history of migraines, hypertension, or autoimmune disorders in pregnancy are at higher risk, as well as following cervical spine manipulations. Prompt diagnosis and management of vertebral artery dissection are essential to ensure favorable outcomes.

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Title: Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature
Authors: Francesca Monari
Stefano Busani
Maria Giovanna Imbrogno
Isabella Neri
Massimo Girardis
Annamaria Ghirardini
Francesca Cavalleri
Fabio Facchinetti
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Migraine
Acetylsalicylic Acid
Sectio Ceasarea
Neck Pain
Acetylsalicylic Acid
Diplopia
Hypertensive Disorder of Pregnancy
Headache
Sectio Caesarea
Vertebral Artery Dissection
Vertebral Artery Dissection
Published in: Journal of Medical Case Reports / Issue 1/2021
Electronic ISSN: 1752-1947
DOI: https://doi.org/10.1186/s13256-021-03090-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature

Abstract

Background

Case presentation

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Case presentation

Conclusion

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