A 40-year-old female had neck manipulation by a
chiropractor for treatment of migraine. She presents shortly after with
occipital headache, pain in the neck, pain and numbness in the right side of
her face, hoarse voice, numbness of the right limbs and right side of her
trunk, vertigo and difficulty in maintaining balance.
On examination, a right-sided Horner's
syndrome was noted. There was nystagmus (fast phase to the right),
sensorineural hearing loss in the right ear and paresis of the soft palate on
the right hand side. There was reduced tone and power in the upper and lower
limbs on the right. Deep tendon reflexes were brisk on the right side and
plantar response was extensor. Sensory examination revealed a crossed
hemianaesthesia with involvement of the face on the right side.
The likely lesion is dissection of the:
Anterior spinal artery
Posterior spinal artery