Suspicious internal hematoma in left V2 segment.Luminal irregularity of right cervical vertebral artery (V2 segment).Flap like structure in axial sections of the TOF MR angiogram.Eccentric intramural crescentic T1 hyperintensity in the medial aspect of right vertebral artery (V2 segment) within the transverse foramen.No significant disc herniation/nerve root compression/discitis. Mild spondylotic changes and posterior bulge of C3-C4, C4-C5, C5-C6 and C6-C7 intervertebral discs causing anterior thecal sac indentation with mild spinal canal compromise. No evidence of acute infarct, hemorrhage, mass lesion, AVM/Demyelination. Normal, Tandem Walking: Normal, No Cerebellar signs, Rest of the neurological examinations normal.Īfter obtaining urgent Neurologist opinion, MRI Brain with MRA and MRI cervical spine imaging were obtained.

She was on oral analgesics for symptomatic pain relief for three days, with no obvious reduction in pain intensity. On probing of the history further, it was learned that the patient had undergone one sitting of external massage for right shoulder pain, following which she had developed this weakness. No associated history of headache, vomiting, fever or trauma.History of right sided neck pain radiating to right shoulder and right arm for 10 days.Sudden onset of right upper limb weakness and inability to lift her right arm for 3 days.Keywords : Neck massage, vertebral artery dissection, neck pain, cervical radiculopathy.Ī 34 years old female, with no known comorbidities presented to ER with complaints of: Anticoagulation was commenced to prevent secondary ischemic events. MRI with MRA cervical spine showed bilateral vertebral artery dissection with intramural hematoma in left V2 segment. In this article, we describe a case of vertebral artery dissection presenting as cervical radiculopathy in a previously healthy 34 years woman who presented with right upper limb weakness and right sided neck pain. Rarely an extracranial vertebral artery dissection may cause a radiculopathy in the absence of brainstem ischemia. *Correspondence: acute cause of neck pain and arm weakness is most commonly due to cervical radiculopathy. MRCEM Resident - 3rd year, Department of Emergency Medicine, Kauvery Hospital, Chennai, India The dangerous massage: vertebral artery dissection

Torn pica artery