Disclosures: Fabienne Saint-Preux, MD: Nothing to disclose

Case Description: 33-year-old female with history of lumbar disc herniation with radiculopathy presents with radiating left sided neck pain for 1 week without inciting event. Cervical spine exam revealed left cervical paraspinal muscle, facet joint, upper trapezius and levator scapulae tenderness, and equivocal Spurling’s sign. Patient was diagnosed with cervical radiculopathy likely secondary to cervical disc herniation. Oral steroids and physical therapy were prescribed. Six days later, patient presented to the ED with left arm/face numbness. Exam revealed decreased sensation in the V1/3 distribution and left arm. CTA head/neck revealed left cervical vertebral artery dissection, patient was started on daily aspirin and outpatient neurology follow up was advised.

Setting: Outpatient spine clinic

Patient: 33-year-old female with radiating left sided neck pain

Assessment/Results: Patient with clinical presentation of progressive left cervical radiculopathy was found to have a vertebral artery dissection as the true etiology of neck pain.

Discussion: Neck pain is a common complaint in spine clinic and the majority of cases are not life threatening. Incidence of cervical artery dissection is low; however, it is a common cause of stroke in adults younger than 50. Similar to cervical radiculopathy, cervical artery dissection can present with gradual neck pain and tenderness to palpation on exam, however the majority of patients also have severe headache which was not seen in this case.

Conclusion: Cervical artery dissection is a serious, albeit rare, cause of neck pain with a high potential for fatal sequelae. In cases of progressive neck pain despite use of oral steroids, cervical vertebral artery dissection should be considered as a potential cause of neck pain particularly in the context of new onset facial and arm numbness.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/pain-in-the-neck-cervical-neck-pain-masking-vertebral-artery-dissection-a-case-report/