Which scenario would trigger an ER stroke alert related to Vertebral Artery Dissection?

Which scenario would trigger an ER stroke alert related to Vertebral Artery Dissection?

• A. Fever with stiff neck
• B. Saddle anesthesia
• C. Sudden severe headache with Horner's after neck adjustment
• D. A tearing chest pain

Answer: (C)

Vertebral artery dissection can lead to a posterior circulation stroke, and neck manipulation is a known trigger that can injure the cervical vessels. When this dissection occurs, one classic presentation is a sudden, severe headache or neck pain, sometimes accompanied by Horner's syndrome (ptosis, constricted pupil, and facial flushing/anidrosis) due to disruption of sympathetic fibers in the neck. The combination of a sudden severe headache with Horner’s after neck adjustment is a red flag for a vertebral artery dissection and warrants immediate ER stroke alert and rapid vascular imaging (such as CT angiography or MR angiography) to assess for arterial injury and potential brain ischemia. Other scenarios don’t fit this pattern: fever with stiff neck points toward meningitis; saddle anesthesia suggests cauda equina syndrome; tearing chest pain is more typical of aortic dissection.

Vertebral artery dissection can lead to a posterior circulation stroke, and neck manipulation is a known trigger that can injure the cervical vessels. When this dissection occurs, one classic presentation is a sudden, severe headache or neck pain, sometimes accompanied by Horner's syndrome (ptosis, constricted pupil, and facial flushing/anidrosis) due to disruption of sympathetic fibers in the neck. The combination of a sudden severe headache with Horner’s after neck adjustment is a red flag for a vertebral artery dissection and warrants immediate ER stroke alert and rapid vascular imaging (such as CT angiography or MR angiography) to assess for arterial injury and potential brain ischemia.

Other scenarios don’t fit this pattern: fever with stiff neck points toward meningitis; saddle anesthesia suggests cauda equina syndrome; tearing chest pain is more typical of aortic dissection.