CF 373: Vertebral Artery Dissection Recognized And Referred By Chiropractor Today, we’re going to talk about Vertebral Artery Dissection Recognized And Referred By Chiropractor But first, here’s that sweet sweet bumper music    

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together. 

You have found yourself smack dab in the middle of Episode #373 Now if you missed last week’s episode, we talked about Spinal Manipulative Therapy and Lumbar Re-operation & SMT And Fall Risk Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

First things first here; we’re gonna be short of episodes for a couple of weeks. I’m heading out early next week for a family end-of-summer trip to the Florida Keys. Key Largo, to be more specific. You guys can have Key West and all of its crazy college kid craziness. I prefer the slower, more laid-back and mature pace of Key Largo.  We go to a resort there called Playa Largo. It’s a Marriott property, and it’s just a wonderful place. Look it up. Just a tip from your ol’ Uncle Jeffro. It’s a resort with restaurants and a spa and such. Your Ol’ Uncle Jeffro has a lil birthday massage scheduled while he’s down there too.  So, we got that going on, and I’m not going to have the opportunity to get the podcast put together next week. We don’t get back that next week from Florida until Wednesday, so, yeah, I won’t have time that following week either.

So, this is it for a couple of weeks.  The new thing for me in my office is the purchase of a radial shockwave unit. We are getting up and running and figuring it out. We did a session, or a sesh as the kids call it, this morning on a vet that has had 3 surgeries on his ankle and until today, hasn’t felt anything in his leg or ankle in over a year.  He walked out today, almost in tears, because it made that much of a difference in one sesh.

That’s a pretty great start to our Shockwave journey. I’m pretty excited to see how it goes.  From our Mastermind group, we have around 25 in the group, and I think I was one of the last to get the shockwave. I think there are still 3-4 of us that have yet to get one. We have two masters of the shockwave in the group. Ben Fergus from Evanston/Chicago area actually teaches the course in the videos from the company, and David Rudnick is one of the Shockwave instructors for the masterclass that we’ll be going out to Atlanta to take in September.  So yeah, we got the smart folks in our Mastermind. Be jealous. 

That’s the big news for this week. I’m cutting it short so I can get the research put together.  Here we go. 

Item #1 Our only one this week is called “Recognition of Vertebral Artery Dissection In a High-Risk Postpartum Patient by a Chiropractic Physician” by Demetrious et al. Et al also includes some of our industry’s heavy hitters like Robert Trager, Stephen Veigh, Peter Tuchin, and my friend Ol’ Uncle David Graber.  I don’t really call him Ol’ Uncle Dave but I may now. Time will tell. This was published in Cureus on August 18, of 2025 and is sizzlin’ like steak. 

Remember, the citations can be found at chiropracticforward.com under this episode. 

Demetrious J, Trager R J, Veigh S, et al. (August 18, 2025) Recognition of Vertebral Artery Dissection in a High-Risk Postpartum Patient by a Chiropractic Physician. Cureus 17(8): e90389. doi:10.7759/cureus.90389

Why They Did It They say, “We report a case of vertebral artery dissection (VAD) in a patient with postpartum preeclampsia and underscore the contribution of chiropractic assessment in recognizing vascular pathology, facilitating neurovascular imaging, and expediting emergency intervention.”

What The Hell Had Happened? A 36-year-old woman with a history of mixed connective tissue disease presented to the emergency department five days postpartum with facial and peripheral edema, recent onset of hypertension, acute severe neck pain, headache, lightheadedness, confusion, and gait instability. 

Magnetic resonance angiography (MRA) and magnetic resonance venography of the head were performed. Small, unruptured bilateral internal carotid artery aneurysms were visualized. The patient was admitted and treated for postpartum preeclampsia. 

Upon discharge, she followed up with a neuroendovascular specialist.  Although the patient improved with preeclampsia management, concerning neurologic symptoms persisted. The patient later consulted a chiropractor, who suspected VAD. 

On the day she sought ED care, her clinical condition rapidly deteriorated. She developed a severe occipital headache and new, excruciating, left-sided posterior neck pain with radiation into the left shoulder.  The pain significantly restricted active cervical rotation bilaterally.

Visual disturbances progressed to include diplopia and intermittent scotomata described as “seeing spots,” along with worsening photophobia.  Additionally, the patient experienced dyspnea, lightheadedness, and progressive bilateral lower extremity edema that impaired ambulation.

So…..looky here folks, I’ve been preaching this stuff on the podcast for years now, and if you, as a doctor, do not know that this patient needs to be punted like a football in the Super Bowl of life, then you need to know it. This is life and death for the patient, and it’s survival or bankruptcy for you as far as your business.  You aren’t going to ‘pop it out’. Working on this patient will not work out for you. Please pay attention to these warning signs. Pay attention to what we’re talking about here. It’s really really important. 

Emergent neck MRA was recommended and performed, confirming VAD 12 days after the initial emergency department visit.  The patient was initiated on antithrombotic therapy, with subsequent resolution of symptoms and no evidence of ischemic stroke.  This case underscores the importance of maintaining a high index of suspicion for VAD in postpartum patients presenting with new-onset neurological symptoms, particularly in the context of hypertensive disorders of pregnancy and underlying connective tissue disease. 

It further illustrates the potential role of chiropractic evaluation in the early clinical recognition of vascular pathology, which may facilitate timely diagnosis and intervention and reduce the risk of stroke. So that’s the story, but I also want to highlight some things that were stated in the paper, in addition to the abstract.  It may cause ischemic stroke, particularly in young adults, and has an incidence rate of approximately two per 100,000 person-years

Notice it’s in YOUNG adults. These stroke cases you see in the news are usually young folks. Not older 

Because I don’t think it can be repeated enough times, they say, “The clinical presentation of VAD may include occipital headache, neck pain, and other potential features such as visual disturbances, dizziness, and gait abnormalities that can be indicative of brain ischemia. 

Risk factors for VAD are increasingly understood, such as hypertension, migraine, and connective tissue disorders.  A tip from your Ol’ Uncle Jeffro – Test with the Beighton Scale and do it often if you see someone that’s looking bendy. If you do an SLR on someone and their knee basically goes backward, do the Beighton. When doing ROM, if they bend right over and put their hands flat on the floor, do the Beighton. You get the idea. 

They say, “Pregnancy is an increasingly recognized risk factor for CeAD and VAD. One study reported that pregnant women had approximately two times the risk of VAD compared to non-pregnant controls, with an elevated incidence of VAD during a one-year window including pregnancy and postpartum”

The chiropractor is the one that recognized it, the chiropractor is the one that recommended the emergency MR-A, and this chiropractor is A-OK with me.  I’m sure the ER probably still asked her if she’d been adjusted by a chiropractor but, you know….that’s comes with the territory, doesn’t it? Another important consideration is that should an adjustment be deemed to CAUSE the stroke, symptoms are going to appear almost immediately. 

With regards to that, they say, “The earlier chiropractic neck manipulation warrants careful contextual analysis. A history of connective tissue disorder, pregnancy, and recent childbirth warrants consideration, as these factors may represent relative risk factors for spinal manipulative therapy.(SMT).

Although some literature suggests an association between cervical manipulation and VAD, high-quality evidence does not support a causal relationship. Importantly, this patient did not experience acute headache, dizziness, or neurological symptoms that may or may not be present in this cohort immediately following the manipulation. These symptoms emerged only postpartum, coinciding with the onset of preeclampsia.

I liked this paper enough that it’s the only one I’m doing this week. It’s important and full of information that demands our focus. So that’s what we’re doing; we’re focusing on this one and only paper this week and I want to thank the crew that put it together. You’re doing God’s work in our profession. 

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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  The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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About the Author & Host Dr. Jeff Williams – Diplomate of the International Academy of Neuromusculoskeletal Medicine (DIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger    

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