We all know it’s smart to write down our symptoms before a visit to our healthcare provider, but most of us simply don’t take the time. In many cases, it may be only subtle symptoms that trigger a proper diagnosis. This is certainly true when it comes to stroke.
There are basically two types of stroke: hemorrhagic stroke and ischemic stroke. A ruptured aneurism, or a leak in an artery, can result in a hemorrhagic stroke while a blood clot that blocks an artery can give rise to an ischemic stroke. Both types often give immediate and obvious nervous system signs and symptoms that typically prompt a call for emergency services.
There is however, a less common and quite subtle type of stroke that is far less discussed and understood. This is called vertebral-basilar insufficiency (VBI) stroke, which is caused by vertebral artery dissection (VAD). This type of stroke is very rare and only occurs 0.75-1.12 times per every 100,000 person years. In VAD/VBI, there may not be ANY history of trauma or event that the person can identify, and it’s most common in 30-50 year olds (not in older-aged people like the other more common types of stroke), which also makes VAD/VBI far less suspect. Symptoms of VBI can be subtle but may include headache, neck pain, chest pain, and perhaps some transient or short-term visual disturbance (blurred vision or double vision, for example). The KEY is a sudden and/or “different” kind of headache, especially if it’s accompanied by some other unusual symptom.
In one case study, a 30-year-old female experienced an “unusual headache” and a short-term loss of her peripheral vision in her left eye with eyelid numbness. This patient also had a history of migraines that typically occurred at menstruation, which led to an inaccurate diagnosis of “ocular migraine”, and she was sent home from the ER. Soon after, she developed right-sided neck pain with a transient right-sided visual disturbance prompting her to visit a chiropractor. The “unusual type of headache” and the visual complaints that she didn’t previously have with her typical migraines caught her chiropractor’s attention. He then ordered a consult and an urgent MRA (magnetic resonant angiography) and MRI of the head confirmed the diagnosis of VAD. With a proper diagnosis and prompt treatment, her symptoms quickly resolved, and the follow-up MRA at the three-month point showed resolution of the VAD.
Neck pain and headaches are COMMON complaints for which people seek chiropractic care. In fact, chiropractic adjustments are strongly recommended in a number of current treatment guidelines. Had “a typical” chiropractic adjustment occurred and the diagnosis of VAD NOT been made, the patient may have progressed to a VBI stroke (which was already in progress BEFORE she even scheduled her chiropractic appointment). Other studies show that neck pain and headaches related to VAD precede visits to both doctors of chiropractic and medical doctors equally and subsequent treatments are typically NOT the cause, as the problem is already present. The good news is that VAD is very uncommon and will hopefully be caught by your doctor and promptly treated so stroke can be avoided.