Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature
| Autor: | Maria Giovanna Imbrogno, Francesca Cavalleri, Stefano Busani, Isabella Neri, Fabio Facchinetti, Massimo Girardis, Annamaria Volpi Ghirardini, Francesca Monari |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty Nausea Vertebrobasilar ischemia Vertebral artery dissection Case Report Pregnancy Vertigo medicine Humans Vertebral Artery Dissection Osteopathy biology business.industry Cesarean Section Angiography General Medicine Cervical spine manipulation biology.organism_classification medicine.disease Magnetic Resonance Imaging Surgery Vomiting Cervical Vertebrae Medicine Female Differential diagnosis medicine.symptom business Postpartum period |
| Zdroj: | Journal of Medical Case Reports Journal of Medical Case Reports, Vol 15, Iss 1, Pp 1-8 (2021) |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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