It’s a Tuesday morning in the clinic, and a young woman, let’s call her Anna, walks in. She’s an avid yoga practitioner, usually full of energy. But today, she looks worried. “Doc,” she says, “I got this sudden, awful headache during my sun salutation yesterday, and I’ve been so dizzy since. It’s not like my usual headaches.” Anna’s story, while unsettling, brings to mind something we doctors always keep an eye out for, especially in younger folks with sudden, unusual symptoms: a Vertebral Artery Dissection. It sounds scary, I know, but let’s talk about what it really means.
What Exactly Is a Vertebral Artery Dissection?
So, what are we talking about here? A Vertebral Artery Dissection is essentially a tear in the wall of one of the vertebral arteries. You have two of these arteries, and they’re pretty important – they run up the back of your neck, nestled near your spine bones (your vertebrae), carrying oxygen-rich blood to your brain and spinal cord.
Think of these arteries like a layered hose. They have three main layers:
- The intima: This is the smooth, inner layer that the blood flows directly against.
- The media: The middle layer, muscular and elastic, helping to keep blood moving in the right direction.
- The adventitia: The tough outer layer that gives the artery its structure and support.
When a dissection happens, blood can sneak between the intima and the media layers. This trapped blood can form a clot, and that clot can create a bulge, kind of like a bump in the hose, which can mess with blood flow. Sometimes, the artery wall itself can swell up, which we call dilation.
Now, the big concern with a Vertebral Artery Dissection is its potential to cause a stroke. This can happen in a couple of ways:
- An ischemic stroke: This is when that clot I mentioned gets big enough to block blood flow to the brain. Or, a piece of the clot can break off, travel downstream, and get stuck in a smaller artery in the brain.
- A hemorrhagic stroke: This is less common but more serious. It happens if the tear goes through all three layers of the artery wall. Blood then spills out of the artery instead of reaching the brain. If this happens inside your head, it can cause bleeding around the brain (a subarachnoid hemorrhage) or directly into the brain tissue.
While it’s a rare cause of stroke in older adults, Vertebral Artery Dissection is actually a more common culprit in folks younger than 45.
It’s worth mentioning that tears can happen in other neck arteries too, like the carotid arteries (the ones in the front of your neck). Any tear in a neck artery is called a cervical artery dissection, and any of these can potentially lead to a stroke. The good news? The overall chance of stroke from these dissections is low, accounting for only about 2% of ischemic strokes. Most ischemic strokes are due to atherosclerosis – that’s the hardening and narrowing of arteries from things like smoking, high blood pressure, or high cholesterol. However, for younger and middle-aged adults, Vertebral Artery Dissection is a leading cause, responsible for up to a quarter of strokes in this group.
What Makes a Vertebral Artery Dissection More Likely?
Sometimes, a Vertebral Artery Dissection can happen seemingly out of the blue, for no clear reason. But often, there are underlying factors or specific situations that can increase the risk.
Certain health conditions can make the artery walls a bit more vulnerable. These include:
- Smoking (always a risk factor for blood vessel problems, isn’t it?)
- Cystic medial necrosis (a condition where the middle layer of the artery wall weakens)
- Connective tissue disorders like Ehlers-Danlos syndrome or Marfan syndrome
- Fibromuscular dysplasia (abnormal cell growth in artery walls)
- Arterial hypertension (high blood pressure)
- Osteogenesis imperfecta (brittle bone disease, which can also affect connective tissues)
- Polycystic kidney disease
- Vasculitis (inflammation of blood vessels)
Injuries can also trigger a dissection. This might happen from keeping your neck in an awkward, over-extended position for a long time (like looking straight up), or from sudden, sharp neck movements or trauma.
Some activities or situations we’ve seen associated with this include:
- Car accidents, even minor ones with whiplash
- Chiropractic adjustments or even very deep tissue neck massages, if not done carefully
- Blowing your nose really hard. Weird, right?
- Certain yoga poses involving neck hyperextension
- Painting a ceiling (that prolonged upward gaze again)
- Receiving cardiopulmonary resuscitation (CPR)
- Forceful sneezing or vomiting
- Wrestling or heavy weightlifting
- Basically, any significant neck injury
Recognizing the Signs: Symptoms to Watch For in Vertebral Artery Dissection
In the early stages, you might not feel a thing. But if the artery actually ruptures, or if a blood clot starts to block blood flow to your brain, you could start to experience symptoms, some of which can be quite sudden and alarming. These are the kinds of things we’d want to hear about right away:
- Neck pain: Often, this is just on one side and can be quite distinct.
- Severe headaches: These can come on suddenly and feel different from typical headaches.
- Dizziness or Vertigo (a sensation like the room is spinning)
- Ataxia (trouble with balance, coordination, or feeling unsteady on your feet)
- Double vision or other visual changes
- Hearing loss, sometimes sudden
- Slurred speech (what we call dysarthria)
If you experience any of these, especially if they’re new or severe, it’s really important to get checked out.
How We Figure Out What’s Going On: Diagnosis
If we suspect a Vertebral Artery Dissection, we’ll need to get some pictures of those arteries in your neck.
The “gold standard” test is often a Magnetic Resonance Angiography (MRA). This is a special kind of MRI that looks specifically at blood vessels. It gives us really detailed images and helps us see the dissection, how bad it is, and if it’s recent.
Now, MRA is a fantastic tool, but not every hospital has one readily available, especially in an emergency. So, often, the first tests someone might have are a Computed Tomography (CT) scan or a CT angiography (CTA). These are quicker and more widely available, and can often give us the diagnosis.
Sometimes, we might need an even closer look. In those cases, a conventional angiography (also called an angiogram) might be recommended. For this, a specially trained doctor (often an interventional radiologist or neurologist) will insert a very thin tube, a catheter, usually into an artery in your wrist or groin. They gently guide it up to the neck arteries, inject a special dye, and then use X-ray imaging to watch the blood flow in real-time. This can show the extent of the dissection very clearly.
Getting You Back on Track: Treatment for Vertebral Artery Dissection
The good news is that many Vertebral Artery Dissections actually heal on their own over time. Our main goal in treatment is usually to prevent a stroke or further complications, mainly by stopping blood clots from forming or getting bigger.
So, the first line of therapy is often blood-thinning medications:
- This might be aspirin or aspirin-like medications such as clopidogrel (Plavix®).
- Sometimes, especially initially, we might use stronger blood thinners like an heparin infusion (given through an IV) or warfarin tablets.
However, if the dissection has already caused bleeding into the brain (a hemorrhagic stroke), or if the tear is very extensive and reaches into the brain arteries, then blood thinners might not be safe. In those cases, or if standard medications aren’t enough, we have other options.
These are typically procedures done by specialists:
- Endovascular embolization: Using those same catheter techniques I mentioned for diagnosis, the doctor can guide tiny coils or a special glue-like substance to the site of the tear to seal off the damaged part of the artery.
- Angioplasty: This involves guiding a catheter with a tiny balloon on its tip to the narrowed or damaged area. Inflating the balloon can help open up the artery or press the torn flap back against the artery wall.
- Stenting: Often done with angioplasty, a tiny mesh tube called a stent can be placed inside the artery to help keep it open and support the damaged wall. This is usually for specific situations, especially if the dissection is inside the brain.
- Surgery: This is much less common nowadays with advances in endovascular techniques. But, if other procedures aren’t possible or haven’t worked, surgery might be needed to clip or repair the affected artery.
We’ll always discuss all the options with you, making sure you understand the pros and cons of each approach for your specific situation.
What to Expect: The Road to Recovery
For most people who experience a Vertebral Artery Dissection, the outlook is generally good, and many make a full recovery. That’s a relief, I know.
However, once you’ve had one dissection, there can be a slightly higher risk of having another one in the future, though this risk does tend to decrease over time.
Living Well After a Dissection
After a Vertebral Artery Dissection, we’ll want to keep a close eye on how things are healing. This usually means regular follow-up appointments and imaging tests, like an MRA, perhaps every three to six months initially, until we’re sure the artery has healed well. You might also need to continue taking a blood thinner during this healing period.
If you’re considered at higher risk for future dissections, your follow-up care might need to continue for many years.
And yes, you can still exercise! But we’ll likely advise you to avoid certain activities, at least for a while, or even long-term in some cases. Things to be cautious about include:
- Exercises where you support your full body weight with your hands/arms, like push-ups and pull-ups.
- Lifting very heavy weights (we often say no more than 25 to 30 pounds, especially overhead).
- Contact sports.
- Roller coaster rides (those sudden G-forces!).
- Chiropractic head/neck manipulations.
- Deep tissue massage directly on your neck.
- Skydiving or other activities with rapid acceleration/deceleration.
- Holding a “plank” position for extended periods (though other yoga or Pilates moves are often fine).
- Anything that could cause a whiplash-type injury or involve long periods of hyperextending your neck.
It’s all about protecting those arteries while they heal and minimizing the risk of another injury.
Key Takeaways on Vertebral Artery Dissection
It’s a lot to take in, so let’s break down the most important bits about Vertebral Artery Dissection:
- It’s a tear in one of the key arteries supplying blood to your brain, located at the back of your neck.
- While rare overall, it’s a more common cause of stroke in younger and middle-aged adults.
- Symptoms can include sudden, severe headache, neck pain, dizziness, and vision or speech problems.
- Certain medical conditions or neck injuries/strains can increase the risk.
- Diagnosis often involves imaging like MRA or CT scans.
- Treatment focuses on preventing stroke, often with blood thinners, but sometimes procedures like stenting are needed.
- Most people recover well, but follow-up and activity modifications are important.
You’re not alone in this. If you ever have concerns or experience symptoms like these, please don’t hesitate to reach out. We’re here to help figure things out and get you the care you need.