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

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.