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Neck pain, headache, and dysdiadochokinesia—what’s the cause?

Figure 1 Quiz of the Week

A 28-year-old female presents to the emergency department with an occipital headache and neck pain. She mentions her symptoms appeared after hyperextending her neck while playing tennis the day before. Examination reveals dysdiadochokinesia and decreased lateral vision. A contrast head and neck CT demonstrate the findings seen here. 

Based on this patient’s probable diagnosis, which of the following treatments is most appropriate?

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Image credit: @jsfaust.


Answer: Antithrombotic therapy

This patient’s presentation is suggestive of a vertebral artery dissection, a common cause of stroke in young adults. Dissection can result from arterial wall trauma, other mechanical triggers, or it may occur spontaneously in patients with underlying predispositions. Antithrombotic therapy, using either antiplatelet drugs or anticoagulation, is the recommended treatment for patients with the condition. Most arterial wall abnormalities typically stabilize or resolve within three to six months.

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