Neck Pain: Stroke Or Something Else?

A sore neck can be a symptom of a stroke, but it is rare. A stroke occurs when there is a tear in the lining of one of the arteries in the neck, known as a cervical artery dissection. This can cause blood clots, which may block blood flow to the brain, resulting in a stroke. While this is uncommon, affecting only about two in 100,000 people per year, it is a leading cause of strokes in people under 50. The risk factors include underlying inherited connective tissue disorders and particular neck movements.

• Trouble speaking or slurred speech
• Confusion or trouble understanding others
• Difficulty seeing with one or both eyes
• Trouble walking or staying balanced or coordinated
• Severe headache with an unknown cause | | What are the causes of a stroke? | - Extreme positioning of the neck
• Trauma or rigorous neck movements
• Keeping the neck extended for a long time
• Frequent vomiting or coughing
• Holding certain yoga poses | | What is cervical artery dissection? | A tear in the lining of one of the neck arteries. | | What is vertebral artery dissection? | A type of cervical artery dissection that occurs when an artery in the neck tears. |

A tear in the neck's main arteries can cause a stroke

A tear in one of the main arteries in the neck is a rare cause of stroke, but it does happen. This is known as cervical artery dissection and it affects the carotid and vertebral arteries, which carry blood to the brain.

The tear occurs in the lining of one of these vessels, allowing blood to leak between the layers of the artery wall and form a clot. This clot can then block blood flow through the artery, or break off and lodge in an artery in the brain, resulting in a stroke. Cervical artery dissection accounts for around 2% of ischemic strokes overall but is a notable cause of stroke in younger people, responsible for as many as one in four strokes among adults under 50.

Cervical artery dissection can happen spontaneously or be triggered by an injury or a drastic neck movement. It is often caused by a neck injury, such as whiplash from a car accident, or other types of injuries that cause extreme neck rotation or extension. Certain physical activities can also cause a tear, including swimming, scuba diving, playing tennis, basketball or volleyball, riding roller coasters, and jumping on a trampoline. Even sneezing or coughing can cause a tear. In rare cases, cervical manipulative therapy or "adjustment" by chiropractors and other health care professionals can lead to a tear.

The symptoms of cervical artery dissection include severe headaches, unusual and persistent neck pain, dizziness, double vision, jerky eye movements, unsteadiness while walking, and slurred speech. If you experience any of these symptoms, it is important to seek immediate medical attention by calling 911.

Treatment for cervical artery dissection includes blood-thinning medications, such as antiplatelet and anticoagulant drugs, as well as pain management for headaches and neck pain.

Cervical artery dissection: a tear in the lining of the neck's arteries

A sore neck can be a symptom of cervical artery dissection, a rare cause of stroke. Cervical artery dissection occurs when there is a tear in the wall of a large blood vessel (artery) in the neck. This can cause blood clots to form in the arteries, which can block blood supply to the brain and result in a stroke.

The two pairs of blood vessels in the neck, the carotid and vertebral arteries, are known as the cervical arteries. They carry blood to the brain. A tear in the lining of one of these vessels is called a cervical artery dissection. This can happen in the carotid or vertebral arteries, with carotid artery tears being more common.

When a cervical artery dissection occurs, blood leaks between the layers of the artery wall and forms a clot. This clot can completely block blood flow through the artery or break off and lodge in an artery in the brain, resulting in a stroke. Cervical artery dissections are more common in younger adults, with underlying inherited connective tissue disorders that make their arteries more prone to tearing. They can also occur due to sudden movements or injuries to the neck, such as high-impact injuries from accidents, minor neck injuries from sports, neck strain from activities like painting, or even from coughing, sneezing, or blowing your nose.

The symptoms of cervical artery dissection can vary and may be vague. They depend on the severity of the artery affected and whether a stroke occurs afterward. Some possible symptoms include severe and sudden head pain, neck pain, stroke-like symptoms such as dizziness, double vision, and slurred speech, pulsating tinnitus, sight problems, and a painful drooping eyelid.

If you experience unusual, persistent neck pain or any stroke-like symptoms, it is important to seek medical attention immediately. While cervical artery dissection is rare, it is important to get a proper diagnosis and treatment to prevent potential complications, such as a stroke.

Warning signs: unusual, persistent neck pain and a severe headache

Unusual, persistent neck pain accompanied by a severe headache can be a warning sign of a stroke. This combination of symptoms may indicate a cervical artery dissection, a rare but serious condition that can lead to stroke, especially in people under 50.

Cervical artery dissection occurs when there is a tear in the lining of one of the arteries in the neck, causing blood to leak between the layers of the artery wall and form a clot. This clot can then break off and lodge in an artery in the brain, resulting in a stroke. The neck pain associated with cervical artery dissection is often unusual and persistent and may spread along the side of the neck up towards the outer corner of the eye. It may also feel like something sharp is stuck in the base of the skull.

If you experience unusual, persistent neck pain and a severe headache, especially if accompanied by other stroke symptoms such as dizziness, double vision, jerky eye movements, unsteadiness while walking, or slurred speech, it is important to seek immediate medical attention by calling for emergency services.

While cervical artery dissection is rare, it is important to be aware of the warning signs and symptoms to ensure prompt diagnosis and treatment, as early intervention is crucial in the event of a stroke.

Chiropractic neck adjustments can cause cervical artery dissection

The risk of this happening is rare, but it is serious enough that some medical professionals advise their patients to avoid high-velocity neck manipulation. While chiropractic therapy may be beneficial for some, it is important to be aware of the potential risks involved.

There have been several reported cases of complications following spinal manipulation, including at least 26 reported deaths following chiropractic spinal manipulation. In one case, a 32-year-old woman underwent chiropractic manipulation and had vertebral artery dissection with a subsequent brainstem infarct. She quickly deteriorated and passed away shortly after arriving at the hospital.

The high-velocity thrust used in cervical manipulation can produce significant strain on the carotid and vertebral vessels, leading to dissection. Once a dissection has occurred, the risk of thrombus formation, ischemic stroke, paralysis, and even death is drastically increased.

It is important to note that chiropractors are not always able to detect the signs and symptoms of a dissection, and there is currently no screening modality available to identify patients at risk for cerebrovascular events following spinal manipulation. As a result, receiving medical clearance prior to cervical manipulation is crucial to reducing the risk of morbidity and mortality.

Open communication between chiropractors and physicians is essential to ensuring patient safety. A low threshold should exist for chiropractors to consult with physicians to ensure that patients are cleared for manipulation and aware of the potential risks.

Cervical myelopathy: a condition that mimics stroke

Cervical myelopathy is a condition that can mimic a stroke, presenting with similar symptoms such as hemiparesis and monoplegia. It is important to distinguish cervical myelopathy from a stroke as the treatment for a stroke, intravenous thrombolysis, would be catastrophic for a patient with cervical myelopathy.

Cervical myelopathy is a form of myelopathy that involves compression of the spinal cord in the cervical spine or neck. This compression can be caused by an injury, tumour, herniated disk, or degenerative changes in the spine. The most common type of cervical myelopathy is cervical spondylotic myelopathy, which occurs due to age-related changes in the structure and function of the spine.

Symptoms of Cervical Myelopathy

Cervical myelopathy can cause a range of symptoms, including:

• Neck pain or stiffness
• Numbness or tingling in the hands and arms
• Muscle weakness in the hands and arms
• Loss of balance and difficulty walking
• Clumsiness and poor coordination of the hands
• Difficulty with fine motor skills, such as buttoning a shirt or holding silverware

Diagnosis and Treatment of Cervical Myelopathy

The early diagnosis of cervical myelopathy is important for successful treatment. However, the symptoms can often be mistaken for normal signs of aging. To diagnose cervical myelopathy, a doctor may perform a physical examination, including tests of muscle strength and reflexes, and may also use imaging techniques such as MRI scans, X-rays, or CT myelograms to visualise the spine.

The treatment for cervical myelopathy aims to eliminate the compression of the spinal cord and prevent worsening of the condition. Nonsurgical options, such as physical therapy and a cervical collar brace, may be recommended initially. However, surgery is often necessary to effectively treat cervical myelopathy and prevent complications. Surgical procedures may involve widening the spinal canal or performing spine decompression surgery with spinal fusion to stabilise the spine.

Frequently asked questions