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PubMed This is a summary of 24 peer-reviewed journal articles Updated
Emergency Medicine · Vertebral Artery Dissection

What Should I Do if I Suspect Vertebral Artery Dissection?

At a Glance

Sudden dizziness, double vision, trouble speaking, loss of balance, or severe neck pain after neck injury or manipulation may signal a tear in a neck artery. Call emergency services immediately, do not drive or receive more neck treatment, even if symptoms improve.

In this answer

4 sections

01

Stop Movement and Get Emergency Help

02

Why You Must Not Wait

03

What to Tell the Emergency Medical Team

04

What to Expect at the Hospital

If you develop sudden new symptoms like dizziness, double vision, trouble speaking, or severe neck pain after a neck injury or neck manipulation, call emergency services (such as 911) immediately. Do not drive yourself to the hospital, and do not allow anyone to perform further neck adjustments or massage on you [1][2]. These symptoms could be early warning signs of a vertebral artery dissection—a tear in the lining of one of the main blood vessels in your neck—which requires rapid medical evaluation to prevent a potentially life-threatening stroke [3][4]. While these symptoms can have other causes, they require urgent assessment because a dangerous cause cannot be safely ruled out at home [5][6].

Stop Movement and Get Emergency Help

The moments after these symptoms begin are critical. If you are at a chiropractor’s office, a physical therapy clinic, or at the site of an injury, stop any ongoing treatment or physical activity immediately [1]. Avoid sudden twisting, manipulation, or strenuous activity, and sit or lie down safely [2]. Follow any instructions given by the emergency dispatcher, but do not try to rigidly immobilize your neck yourself unless they tell you to do so.

Do not attempt to drive yourself to the emergency room. A dissection or stroke can rapidly affect your balance, vision, and level of consciousness, making driving extremely dangerous [3][5].

Why You Must Not Wait

It is common for people to assume that neck pain, headache, or dizziness after an injury or adjustment is just a muscle strain or an inner-ear issue. However, you should never assume these symptoms are harmless, especially if they are sudden, severe, or accompanied by neurological changes like loss of balance, facial droop, or trouble swallowing [7][8].

Early diagnosis is time-critical. A tear in the artery wall can cause a blood clot to form. If that clot breaks loose, it can travel to your brain and cause a delayed stroke hours or even days after the initial injury [9][10]. Prompt treatment reduces the risk of permanent neurological damage [11]. Even if your symptoms seem to improve or fade away completely, you still need immediate evaluation; transient symptoms may represent a transient ischemic attack (TIA) or another urgent problem [4][12].

What to Tell the Emergency Medical Team

When speaking with paramedics and emergency room staff, be specific. Clear communication helps the medical team determine the correct testing and treatment. Tell them:

  • Exactly what happened: Describe the injury, impact, or type of neck manipulation you experienced [13][14].
  • The exact timeline: Tell them precisely when the event occurred and when each of your symptoms started [13].
  • Every symptom you felt: Mention everything, including dizziness, headache, severe neck pain, vision changes, difficulty speaking or swallowing, facial drooping, numbness, or weakness [4][15].
  • Symptoms that went away: It is crucial to report if you lost your vision or felt dizzy for a few minutes but then felt better [4].
  • Your medications and history: List all current medications (especially aspirin or anticoagulants), drug allergies, and kidney disease (which can affect imaging choices). Mention if you have a history of migraines, blood vessel disorders, previous artery dissections, or if you are pregnant or recently gave birth [13][16].

Do not take aspirin or any other medication on your own before being evaluated by the emergency team.

What to Expect at the Hospital

Because a vertebral artery dissection can restrict blood flow to the back of your brain, the emergency team will treat your arrival with urgency. They will perform a neurological exam to check your speech, eye movements, strength, and balance. Because early exams can sometimes appear normal even when a dissection is present, they will likely order specialized imaging [12].

To see the blood vessels in your neck and look for tears or clots, the standard first step is usually a CT Angiogram (CTA) of your head and neck [17][18]. A CTA uses contrast dye to clearly show blood vessels, whereas a routine, non-contrast CT scan mainly looks for bleeding and may not show a dissection [17][18]. In some cases, doctors may also use an MR Angiogram (MRA), which uses MRI technology, to get more detailed images of the vessel walls [19][20].

If a dissection is found, treatment is individualized based on the scan results, your bleeding risk, and whether a stroke has occurred. Clinicians may prescribe an antiplatelet drug or an anticoagulant (often called blood thinners) [21][22]. In specific situations involving a large stroke or severe blockage, specialized procedures to restore blood flow may be considered [23][24]. Once diagnosed, you will need a follow-up plan to monitor healing and guide when it is safe to resume activities, which is covered in detail in the rest of this guide.

Common questions in this guide

What should I do if I develop possible vertebral artery dissection symptoms after a neck injury or manipulation?
Call emergency services immediately. Stop any activity, sit or lie down safely, do not drive yourself, and do not allow further neck manipulation or massage.
Which symptoms after neck injury or manipulation need emergency care?
Sudden dizziness, double vision, trouble speaking, severe neck pain, loss of balance, facial drooping, trouble swallowing, numbness, or weakness require immediate evaluation. Call emergency services even if the symptoms improve or disappear.
Should I take aspirin before I am checked for a possible vertebral artery dissection?
No. Do not take aspirin or another medication on your own before emergency evaluation, because clinicians must assess your imaging findings and bleeding risk before choosing treatment.
What imaging tests can detect a vertebral artery dissection?
A CT angiogram of the head and neck is commonly used first to examine the blood vessels. An MR angiogram may be used in some cases, while a routine non-contrast CT scan may not show the artery tear.
Can vertebral artery dissection symptoms go away and still be dangerous?
Yes. Symptoms that fade may represent a transient ischemic attack or another urgent problem, and a clot can cause a stroke hours or days after the initial injury. Immediate medical evaluation is still needed.
What information should I give paramedics or emergency staff?
Describe the injury or manipulation, when it happened, exactly when each symptom began, and any symptoms that resolved. Also report your medications, allergies, kidney disease, pregnancy or recent childbirth, and any history of blood vessel disorders or previous dissections.

Questions For You

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Related questions

Can Neck Pain or Headache Mean Vertebral Artery Dissection? Can a Normal Early MRI Miss a Posterior Circulation Stroke? What Do V1–V4 and Vertebral Artery CTA/MRA Terms Mean? What Is a Vertebrobasilar Drop Attack vs. Syncope? Can a Posterior Circulation TIA Occur Without Weakness?
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What Does the Vertebral Artery Supply? Insufficiency Signs Can Vertebral Artery Insufficiency Cause Hearing Loss? Which Test Is Best for Vertebral Artery Insufficiency? What Is DSA for Vertebral Artery Disease and Its Risks? What Is the Difference Between VAI, VBI, TIA, and Stroke? Can Neck Ultrasound Diagnose Vertebral Artery Insufficiency? How Is BPPV Different From Vertebral Artery Insufficiency? Why Do VBI Symptoms Persist Despite Normal Imaging? Can Dizziness When Turning My Head Be Bow Hunter Syndrome? Why Do VBI Symptoms Come and Go? Is It Still an Emergency? Can Isolated Dizziness Mean Vertebral Artery Insufficiency? Why Is Dynamic Imaging Used for Bow Hunter Syndrome? Can a Heart Clot Cause Vertebrobasilar Insufficiency? What to Do While Awaiting Help for a Vertebrobasilar Stroke?

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Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Given my symptoms, are we ordering a CTA or MRA to specifically look at the blood vessels in my neck, rather than just a routine CT scan?
  2. 2.Are you consulting with a stroke neurologist or vascular specialist regarding my imaging results?
  3. 3.What specific warning signs should I watch for over the next few days that would require me to come right back to the emergency room?
  4. 4.What activity or neck movement is safe for me to do until I am fully cleared?
  5. 5.What medications should I take, and what should I absolutely avoid?

References

References (24)
  1. 1

    Symptoms of Patients With Vertebral Artery Dissection Presenting to Chiropractors: A Systematic Review and Meta-Analysis.

    Trager RJ, Troutner AM, Pikus HJ, et al.

    Cureus 2023; (15(12)):e51297 doi:10.7759/cureus.51297.

    PMID: 38283533
  2. 2

    Transoral ultrasound for bedside diagnosis of vertebral artery dissection in ICU patients with limited cervical access: a case report.

    Cheong I, Feijóo JA, Carruega MC, Tamagnone FM

    Journal of ultrasound 2026; (29(2)):475-483 doi:10.1007/s40477-025-01086-9.

    PMID: 40983782
  3. 3

    Pearls for the Emergency Clinician: Posterior Circulation Stroke.

    Pelletier J, Koyfman A, Long B

    The Journal of emergency medicine 2023; (65(5)):e414-e426 doi:10.1016/j.jemermed.2023.07.007.

    PMID: 37806810
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    A review of carotid and vertebral artery dissection.

    Clark M, Unnam S, Ghosh S

    British journal of hospital medicine (London, England : 2005) 2022; (83(4)):1-11 doi:10.12968/hmed.2021.0421.

    PMID: 35506728
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    Pitfalls in the Diagnosis of Posterior Circulation Stroke in the Emergency Setting.

    Hoyer C, Szabo K

    Frontiers in neurology 2021; (12()):682827 doi:10.3389/fneur.2021.682827.

    PMID: 34335448
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    Factors Associated with Stroke Misdiagnosis in the Emergency Department: A Retrospective Case-Control Study.

    Venkat A, Cappelen-Smith C, Askar S, et al.

    Neuroepidemiology 2018; (51(3-4)):123-127 doi:10.1159/000491635.

    PMID: 30092562
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    The Clinical Features of Dissection of the Cervical Brain-Supplying Arteries.

    Arning C, Hanke-Arning K, Eckert B

    Deutsches Arzteblatt international 2022; (119(35-36)):581-587.

    PMID: 35734920
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    Vertebral Artery Dissection: A Pain in the Neck.

    Covello BR, Chukus A

    Cureus 2021; (13(1)):e12985 doi:10.7759/cureus.12985.

    PMID: 33659122
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    Imaging of Vertebral Artery Dissection in Children: An Underrecognized Condition with High Risk of Recurrent Stroke.

    Little SB, Sarma A, Bajaj M, et al.

    Radiographics : a review publication of the Radiological Society of North America, Inc 2023; (43(12)):e230107 doi:10.1148/rg.230107.

    PMID: 37971932
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    Headache and transient visual loss as the only presenting symptoms of vertebral artery dissection: a case report.

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    Journal of medical case reports 2016; (10(1)):105 doi:10.1186/s13256-016-0893-8.

    PMID: 27113722
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    A Case of Delayed Traumatic Vertebral Artery Dissection.

    Dunay SN, Perreault MD, Grubish LK

    Military medicine 2018; (183(5-6)):e276-e277 doi:10.1093/milmed/usx096.

    PMID: 29415135
  12. 12

    Modified Split-Scan Computed Tomography (CT) Diagnostics of Severely Injured Patients: First Results from a Level I Trauma Center Using a Dedicated Head-and-Neck CT-Angiogram for the Detection of Cervical Artery Dissections.

    Popp D, Thiedemann C, Bäumler W, et al.

    Journal of clinical medicine 2020; (9(8)) doi:10.3390/jcm9082568.

    PMID: 32784360
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    Risk Factors and Clinical Presentation of Cervical Arterial Dissection: Preliminary Results of a Prospective Case-Control Study.

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    The Journal of orthopaedic and sports physical therapy 2015; (45(7)):503-11 doi:10.2519/jospt.2015.5877.

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    Review article: Non-penetrating neck artery dissection in young adults: Not to be missed!

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    Traumatic Vertebral Artery Dissection and Basilar Artery Occlusion/Stroke in a 7-Year-Old Child: A Case Report.

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    Case report: Cervical artery dissection in a patient with Turner Syndrome.

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    A Routine Neck Massage, a Devastating Stroke: Imaging Clues to Vertebral Artery Dissection.

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This page is for informational purposes only and does not constitute medical advice. If symptoms suggest vertebral artery dissection after a neck injury or manipulation, call emergency services rather than driving yourself or waiting for symptoms to improve.