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

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...

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Autores principales: Monari, Francesca, Busani, Stefano, Imbrogno, Maria Giovanna, Neri, Isabella, Girardis, Massimo, Ghirardini, Annamaria, Cavalleri, Francesca, Facchinetti, Fabio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8527659/
https://www.ncbi.nlm.nih.gov/pubmed/34670622
http://dx.doi.org/10.1186/s13256-021-03090-z
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author Monari, Francesca
Busani, Stefano
Imbrogno, Maria Giovanna
Neri, Isabella
Girardis, Massimo
Ghirardini, Annamaria
Cavalleri, Francesca
Facchinetti, Fabio
author_facet Monari, Francesca
Busani, Stefano
Imbrogno, Maria Giovanna
Neri, Isabella
Girardis, Massimo
Ghirardini, Annamaria
Cavalleri, Francesca
Facchinetti, Fabio
author_sort Monari, Francesca
collection PubMed
description 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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spelling pubmed-85276592021-10-25 Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature Monari, Francesca Busani, Stefano Imbrogno, Maria Giovanna Neri, Isabella Girardis, Massimo Ghirardini, Annamaria Cavalleri, Francesca Facchinetti, Fabio J Med Case Rep Case Report 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. BioMed Central 2021-10-20 /pmc/articles/PMC8527659/ /pubmed/34670622 http://dx.doi.org/10.1186/s13256-021-03090-z Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Monari, Francesca
Busani, Stefano
Imbrogno, Maria Giovanna
Neri, Isabella
Girardis, Massimo
Ghirardini, Annamaria
Cavalleri, Francesca
Facchinetti, Fabio
Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature
title Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature
title_full Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature
title_fullStr Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature
title_full_unstemmed Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature
title_short Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature
title_sort vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8527659/
https://www.ncbi.nlm.nih.gov/pubmed/34670622
http://dx.doi.org/10.1186/s13256-021-03090-z
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