Our bodies contain a vast system of blood vessels, veins, and arteries, all of which carry blood to and from the heart. Without adequate blood flow to all parts of the body, we can suffer a wide variety of life-threatening health complications, including death. One type of circulatory complication that has received more medical attention recently is the vertebral artery dissection (VAD), which most commonly results from traumatic accidents. One type of traumatic accident that can cause this injury is chiropractic manipulation. Below, we break down the details of vertebral artery dissections, including what they are, what health complications they can lead to, how chiropractic manipulation can cause VAD, and whether or not you can take legal action for VAD.
If you or a loved one has suffered a major injury, illness, or death due to a medical professional’s negligence, you may have grounds to file a medical malpractice lawsuit. Call 312-321-1111 to schedule a free consultation with a Chicago vertebral artery dissection lawyer at Curcio & Casciato today.
What are Vertebral Arteries?
Vertebral arteries are large tubes in the neck that carry blood from the heart to the brain and spine. There are two vertebral arteries – the left vertebral artery and the right vertebral artery – that branch off from the aorta in the clavicle area, run through the cervical vertebrae in the neck, and join together at the base of the skull. The combined section of the vertebral arteries is called the basilar artery. All together, these arteries create the vertebrobasilar system.
Carotid Artery vs. Vertebral Artery
The carotid arteries begin in the chest area and travel up the neck, where they separate (or bifurcate) into two other arteries: the internal carotid artery and the external carotid artery.
Both the carotid and vertebral arteries play important roles in a healthy circulatory system and central nervous system. According to the Cleveland Clinic, the vertebral arteries provide approximately 20% of blood flow to the brain, while the carotid arteries provide approximately 80% to the brain.
What is Vertebral Artery Dissection?
A vertebral artery dissection (VAD) occurs when one or more layers of the artery tear. Meanwhile, a bilateral vertebral artery dissection occurs when one or more layers of both arteries tear. There are three layers of the cervical vertebral artery:
- Intima: This is the innermost layer of the vertebral artery.
- Media: This is the middle layer of the vertebral artery that helps blood flow move in the right direction.
- Adventitia: This is the outer layer of the artery that maintains the artery’s overall structure.
When a cervical arterial dissection occurs, blood will get trapped between the intima and media layers of the artery. This can create a “bulge” in the artery, which disrupts the rest of the blood flow. This is what’s known as a blood clot.
Traumatic vs Spontaneous Vertebral Artery Dissection
Traumatic dissection occurs when physical force or injury causes a tear in the inner lining of the vertebral artery, leading to separation of the arterial wall layers. This type of dissection is often linked to blunt trauma, cervical spine fractures, or sudden neck movements from accidents or falls.
Spontaneous vertebral artery dissection occurs without obvious trauma or external force, typically resulting from a weakness in the arterial wall. It may be associated with connective tissue disorders, hypertension, or minor neck movements. Diagnosis usually involves MRI or CT angiography.
Left Vertebral Artery Dissection
Left dissection occurs when a tear forms in the inner lining of the vertebral artery on the left side of the neck, allowing blood to enter the arterial wall and separate its layers. This can restrict blood vessels, potentially leading to symptoms such as headache, neck pain, dizziness, visual disturbances, or even stroke. Causes include trauma, sudden neck movement, or underlying connective tissue disorders.
Right Vertebral Artery Dissection
Right dissection involves a tear in the inner lining of the vertebral artery on the right side of the neck, causing blood to enter and separate the arterial wall layers. This condition can increase the risk of ischemic stroke. Common symptoms include neck pain, headache, vertigo, unsteadiness, or visual changes. It may result from trauma, sudden neck rotation, or underlying vascular conditions.
Cervical Artery Dissection
Cervical artery dissection involves a tear in one of the major arteries in the neck, typically the vertebral or carotid artery, leading to separation of the arterial wall layers. Cervical dissections can occur spontaneously or as a result of trauma and are a leading cause of stroke in young and middle-aged adults. Common symptoms of cervical arterial dissections include neck pain, headache, dizziness, visual disturbances, or neurological deficits. Diagnosis of cervical artery dissection is typically confirmed with MRI or CT angiography.
Craniocervical Arterial Dissection
Craniocervical arterial dissection refers to a tear in the lining of arteries that supply blood to the brain, specifically within the cervical and cranial segments of the carotid and vertebral arteries. Craniocervical arterial dissections can disrupt blood vessels and lead to clot formation, increasing the risk of ischemic stroke. It may result from trauma, underlying connective tissue disorders, or occur spontaneously.
Intracranial Vertebral Artery Dissection
Intracranial vertebral artery dissection occurs when a tear develops in the portion of the vertebral artery located within the skull. Extensive intracranial dissection can lead to subarachnoid hemorrhage or ischemic stroke, depending on whether the dissection causes vessel rupture. Intracranial artery dissection may occur spontaneously or after minor trauma and is more common in younger individuals. Symptoms often include a sudden, severe headache, dizziness, nausea, or neurological deficits.
Internal Carotid Artery Dissection
A tear in the lining of the internal carotid artery, typically in the neck. Like vertebral dissection, internal carotid artery dissection can cause stroke, especially in younger adults. Symptoms may include headache, facial pain, partial Horner’s syndrome, or stroke signs.
Intracranial Carotid Artery Dissection
A rarer but serious variant where the tear occurs in the carotid artery after it enters the skull. It can cause subarachnoid hemorrhage or cerebral ischemia.
Cerebral Artery Dissection
Cerebral artery dissection involves a tear in the wall of an artery located within the brain itself. Unlike cervical dissections, these occur entirely intracranially and are less common but often more dangerous. Cerebral artery dissections can lead to subarachnoid hemorrhage if the vessel ruptures or cause strokes. Cerebral dissections may result from trauma, connective tissue disorders, or occur spontaneously. Diagnosis typically requires high-resolution MRI or CT angiography, and treatment depends on the location and severity.
Aortic Dissection (Type A and B)
A life-threatening condition involving a tear in the aorta’s inner layer. Although not cervical or cranial, it’s the most well-known dissection and may be mentioned for contrast or differential diagnosis.
Spinal Artery Dissection
Very rare and involves the arteries supplying the spinal cord. May present with spinal cord ischemia, pain, or paralysis.
Posterior Inferior Cerebellar Artery Dissection
A subset of intracranial vertebral dissections where the dissection extends into a posterior inferior cerebellar artery branch, possibly causing lateral medullary syndrome.
Vertebral Artery Dissection Symptoms
Symptoms of a traumatic or spontaneous dissection of the vertebral artery include:
- Poor coordination and balance
- Neck pain (usually on one side)
- Severe headache
- Vertigo
- Dizziness
- Hearing loss
- Double vision (or loss of vision)
- Difficulty speaking
If you or a loved one has experienced any of these neurological symptoms after cervical manipulative therapy, you may have grounds to contact a Chicago chiropractic malpractice lawyer at Curcio & Casciato.
How is Vertebral Artery Dissection Diagnosed?
Vertebral artery dissection is diagnosed using a combination of clinical evaluation and vascular imaging. Physicians typically begin with a neurological exam to assess symptoms such as headache, neck pain, vertigo, or stroke-like deficits. Imaging studies are essential for confirmation. Magnetic resonance imaging (MRI) combined with magnetic resonance angiography (MRA) is commonly used to visualize the arterial wall and detect intramural hematoma or narrowing. Computed tomography angiography (CTA) is another widely used modality that offers rapid and detailed views of the vertebral arteries. In select cases, digital subtraction angiography (DSA) may be performed for high-resolution imaging.
Differential Diagnosis
The differential diagnosis includes a range of conditions that can mimic its symptoms. Migraine is a common consideration, particularly when pain is unilateral and accompanied by aura-like symptoms. Tension-type or cluster headaches may also resemble the early stages of dissection. Cervical radiculopathy or musculoskeletal neck strain can present with similar symptoms.
Stroke from other causes must be ruled out when neurological signs are present. Infections like meningitis or encephalitis, and structural lesions, like brain tumors or Chiari malformation, may also present similarly. Comprehensive evaluations and imaging are crucial to distinguish vertebral artery dissection from other conditions.
Vertebral Artery Dissection Treatment
Once a cervical artery dissection is diagnosed through an angiography or magnetic resonance imaging (or a combination of the two tests called a magnetic resonance angiography), doctors will determine the best treatment method.
How is Vertebral Artery Dissection Treated?
If you just suffer an arterial dissection and no stroke or brain hemorrhage, then doctors will allow the dissection to heal on its own. They may provide supportive care, such as anticoagulation treatment, to reduce the risk of blood clots during the healing process.
If you suffer a stroke after your vertebral dissection, doctors may proceed with an endovascular treatment in order to remove a blood clot from the brain. Other possible treatments that doctors may recommend (depending on the severity of your tear and your other complications) include an angioplasty, intracranial stenting, endovascular embolization, or surgery.
Vertebral Artery Dissection Stroke – Risk Factors
The most severe cases of cervical artery dissection (and carotid artery dissection) can lead to a stroke. There are two main types of strokes you can suffer from after a VAD, depending on how many of the artery layers are torn.
Ischemic Stroke (Anterior Circulation)
An ischemic stroke can occur when a blood clot is so large that it blocks the majority of the blood flow to the brain. This can also happen if the blood clot breaks off, travels up into the brain, and blocks an artery there. Ischemic strokes are caused by
- Carotid artery dissection: A tear leads to thrombus formation or artery narrowing.
- Aortic dissection (Type A): Dissection can extend into carotid branches or send emboli into the anterior circulation.
Posterior Circulation Stroke
Posterior circulation strokes are caused by:
- VAD
- Posterior inferior cerebellar artery dissection
- Spinal artery dissection (though not a classic stroke): Can lead to spinal cord infarction through arterial occlusion.
Hemorrhagic Stroke (Subarachnoid Hemorrhage)
A subarachnoid hemorrhage, or hemorrhagic stroke, occurs when all three layers tear and, as a result, blood spills out into the space between the brain and the skull and never reaches the brain. Sometimes, depending on the location of the dissection, blood can spill out into the surrounding space of the brain. Subarachnoid hemorrhages are caused by:
- Intracranial vertebral artery dissection
- Intracranial carotid dissection
- PICA dissection (intracranial segment)
Retinal Artery Occlusion (Vision Loss)
This is caused by carotid dissection. Thromboembolism may travel into the ophthalmic artery, blocking blood supply to the retina.
Each stroke type results from either thromboembolism, hypoperfusion, or vessel rupture, depending on the location and nature of the arterial dissection.
Vertebral Artery Dissection Causes
Violent and sudden neck movements from cervical spine manipulation therapy, car accidents, slip and fall accidents, or violent assaults are the most common causes of cervical artery dissections. Other less common causes of vertebral artery dissections include:
- Hyperextending your neck during exercise, such as yoga.
- Lifting heavy weights or objects.
- Wrestling.
- Extending your neck for long periods of time (for example, extending your neck for several hours while painting a ceiling).
- Popping the neck too hard.
- Receiving CPR.
- Sneezing, coughing, or blowing your nose too hard.
- Vomiting.
Vertebral Artery Dissection From Chiropractic Cervical Manipulation (Chiropractors Treating Neck Pain)
Vertebral artery dissection has been associated with neck manipulation, particularly high-velocity chiropractic adjustments. Neck manipulation is a chiropractic treatment in which a chiropractor forcefully pops and realigns sections of the spine. They will typically do this by asking the patient to lie or twist in certain ways while they apply force to the spinal column with their hands. In order to realign the cervical spinal joints, the chiropractor will twist the neck in certain ways until it pops.
Most of the time, patients do not experience any negative complications from neck manipulation. In fact, a 2015 study states that approximately 1 in 20,000 neck manipulations resulted in a vertebral artery dissection (although the incidence could be much higher). 60% of chiropractor-related VAD results in subarachnoid hemorrhage.
Vehicle Accidents and VAD
Vehicle accidents, especially those involving rapid deceleration or whiplash, are a known cause of vertebral artery dissection. Sudden neck hyperextension, rotation, or flexion during a collision can stretch or tear the arterial wall, leading to intramural hematoma and restricting blood vessels. VAD from crashes may not produce symptoms immediately.
If you’ve suffered injuries or a stroke after a car crash, contact a car wreck lawyer in Chicago, IL, for a free consultation.
Medical Malpractice-Related VAD
Vertebral artery dissection can occur as a result of medical malpractice when a healthcare professional causes trauma to the artery during surgeries involving the neck or upper spine. Risk arises during surgeries, catheter placements, intubations, or even improper positioning of the neck. Failure to recognize or respond to early signs of dissection may also constitute negligence. If a provider breaches the standard of care and the dissection leads to stroke or other harm, it may form the basis for a medical malpractice claim.
If you were a patient who suffered, contact a medical negligence attorney in Chicago, IL, for a free case evaluation.
Life Expectancy After Vertebral Artery Dissection
Although a VAD is considered a major medical emergency, up to 80% of patients survive and make a full recovery. The risk of death is highest in patients who suffer strokes, subarachnoid hemorrhage, extensive intracranial dissection, and/or brainstem infarction as secondary complications of the original injury.
Can You Sue a Chiropractor for Vertebral Artery Dissection?
Yes, you can sue if VAD was caused by someone else’s negligence or violence. For example, if you suffered an arterial dissection from a neck manipulation, you may have grounds to file a medical malpractice lawsuit against the negligent chiropractor.
A Chicago chiropractor malpractice lawyer can help you prove these 4 elements of negligence through pieces of evidence such as medical records, witness statements, expert medical opinions, and so much more.
Vertebral Artery Dissection Lawsuit
In order to build a successful medical malpractice claim, you must prove the 4 D’s of negligence in Illinois:
- Duty of Care: All healthcare professionals owe their patients a duty of care to provide safe and competent medical care. All drivers also owe a duty of care on the roads.
- Duty Dereliction: The defendant breached this duty of care by committing a negligent action or inaction.
- Direct Cause: The person suffered VAD, acute ischemic stroke, posterior circulation stroke, or other stroke as a result of negligence.
- Damages: The plaintiff suffered a variety of damages as a result of their injury; therefore, they should receive fair compensation.
Financial Compensation in Illinois VAD Claims
If you have suffered a cervical artery dissection from spinal manipulative therapy, you can receive a settlement that covers all of your damages, including:
- Past and future medical expenses
- Past and future rehabilitative expenses
- Expenses associated with necessary medical equipment (wheelchairs, feeding equipment, voice-activated devices, etc.)
- Caregiving expenses
- Lost wages
- Loss of earning capacity if you suffer a permanent disability that prevents you from doing your job
- Physical pain and suffering
- Emotional distress
- Mental health counseling expenses
- Loss of consortium
- Decreased quality of life
- Average funeral and burial expenses if the cervical artery dissection results in wrongful death
Chicago Vertebral Artery Dissection Lawyer
Our Chicago vertebral artery dissection attorney team has recovered nearly $40,000,000 in combined medical malpractice settlements. We can take on all types of malpractice cases in Illinois. Call 312-321-1111 to schedule a free consultation at our law firm today.