Chiropractic Referral for Computed-Tomography Angiography to Rule Out Vertebral Artery Dissection: A Case Report.

OBJECTIVE

This paper describes a case of chiropractic referral to medical emergency services for computed-tomography angiography (CTA) imaging to rule out vertebral artery dissection (VAD).

CLINICAL FEATURES: A 50-year-old female presented to a chiropractic physician with an idiopathic onset of neck pain, headache, nausea, and dizziness. Differential diagnosis included VAD, internal carotid artery dissection (ICAD), as well as cerebral aneurysm or other intracranial abnormality. Due to symptoms of potential VAD, the patient was referred to medical emergency services for CTA imaging to rule out VAD. CTA revealed a possible posterior communicating artery (PCom) aneurysm vs. infundibulum, and left C3-C4 facet arthropathy. No VAD was noted.

INTERVENTION/OUTCOME: The patient was referred to a neurosurgeon who concluded the patient's abnormality was an incidental finding of infundibulum, not an aneurysm. The patient was referred to physical therapy for treatment of the C3-C4 facet arthropathy, which resolved her symptoms.

CONCLUSION

This case report highlights the role of chiropractors in interdisciplinary care by referring suspected non-neuromusculoskeletal conditions to medical emergency services for advanced imaging to ensure patient safety.