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 Best of Five 3.5

 

   

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BOF:3.5

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:

a)      Vertebral artery

b)      Carotid artery

c)      Basilar artery

d)      Anterior spinal artery

e)      Posterior spinal artery

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