# Vertebral Artery Dissection Following High Velocity Low Amplitude Cervical Manipulation: A Case Report

## TL;DR

A 70-year-old woman suffered a vertebral artery dissection after neck manipulation, leading to stroke-like symptoms and requiring careful treatment.

## Contribution

This case report adds to the understanding of VAD as a rare but serious risk of cervical spinal manipulation therapy.

## Key findings

- The patient developed acute expressive aphasia following chiropractic neck manipulation.
- Imaging showed a vertebral artery occlusion and dissection in the context of vascular hypoplasia.
- Conservative management led to near-baseline recovery, emphasizing early diagnosis and multidisciplinary care.

## Abstract

Vertebral artery dissection (VAD) is a rare but potentially serious cause of posterior circulation stroke, occasionally associated with high-velocity, low-amplitude cervical spinal manipulation therapy (CSMT). We present the case of a 70-year-old female who developed acute expressive aphasia following chiropractic neck manipulation. Imaging revealed a proximal right vertebral artery occlusion with findings suggestive of dissection in the setting of vascular hypoplasia. The patient was managed conservatively with blood pressure control, antithrombotic therapy, and rehabilitation, ultimately returning to near-baseline function. This case highlights the importance of recognizing VAD as a potential complication of cervical manipulation and underscores the value of early diagnosis, thorough vascular imaging, and multidisciplinary management.