A “crick” in the neck followed by massage offered him a stroke: An uncommon case of vertebral artery dissection

Background Vertebral artery dissection (VAD) is an important cause of stroke in young and a known complication of spinal manipulation procedures, although dissection following neck massage has rarely been reported in literature. Head and neck massage by improperly trained salon employees is very popular and widely practiced in developing countries like India. In the present report we present a case of VAD following neck massage. Material and Methods We present an unusual case of VAD in a 30-year-old male patient following an episode of neck massage. He developed headache, nausea, vomiting, blurred vision, diplopia, dizziness, and ataxia following the procedure. Initial history and examination suggested that the patient's symptoms were vascular in origin. We also discuss a brief review of the pathology, diagnosis, symptomatology, treatment, prognosis, and occurrence of this rare entity. Results Computed tomography and magnetic resonance imaging of the brain revealed acute infarction of the left cerebellar hemisphere. Digital subtraction angiography showed narrowing and dilatation of the V3 segment of the left vertebral artery with narrowing of the V4 segment consistent with dissection, along with a cavernous segment aneurysm of the contralateral internal carotid artery. Conclusion This report illustrates the potential hazards associated with neck massage. The vertebral arteries are at risk for dissection, which can lead to acute stroke. This case also suggests that careful history taking and awareness of the symptoms of VAD are necessary to diagnose this entity as timely diagnosis and treatment can prevent permanent disability or even death.