A tear in artery leaves behind pain

Dear Dr. Roach: Our 44-year-old daughter had an event called VAD, vertebral artery dissection — a tear in an inner artery. She was very fortunate to have been seen by an emergency room doctor who had heard of VAD and immediately put her on aspirin and Plavix to try to prevent a stroke. The pain was a level 9 out of 10 for the first two weeks, presenting itself as a dagger in her left temple. She did have a small stroke, which has triggered continuing vertigo. The prognosis is unknown for the healing. Her base headache is a 2-3 with occasional bouts of an 8-9 pain level six weeks later.

What do you know about this malady? Her tear was most likely caused by coughing at the end of a mild case of pneumonia. — Anon.

Vertebral artery dissections are not common, happening in less than 1 in 100,000 people per year. The initial symptoms can be nonspecific, but sometimes there are more-specific findings a skilled examiner can recognize.

Stroke is common, even when treated with anti-platelet drugs such as aspirin and clopidogrel (Plavix). Even minor trauma, such as sports or coughing and sneezing, may trigger the dissection, where blood forces its way between two layers of the blood vessel wall.

The prognosis is generally very good for people with vertebral artery dissection, and depends mainly on the size of the stroke. Given the small stroke for your daughter, it’s likely she will have a good outcome. As many as 90% of people with vertebral artery dissection had an excellent outcome.

Most authorities advise against contact sports and chiropractic manipulation of the neck after an artery dissection. She should not take estrogen, such as birth control pills or hormone replacement; estrogen can affect the arterial wall.