Vertebral Artery Dissection Differential Diagnoses

Updated: Feb 21, 2019
  • Author: Eddy S Lang, MDCM, CCFP(EM), CSPQ; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Diagnostic Considerations

Important diagnostic considerations include the following:

  • Consider the diagnosis of verterbral artery dissection (VAD). The routine emergency department (ED) evaluation of headache (computed tomography [CT] scanning and lumbar puncture [LP]) fails to identify patients with VAD. Most patients are evaluated by one other physician before the diagnosis of VAD is established.

  • Differentiate between the pain associated with VAD and musculoskeletal pain in the absence of a significant mechanism of injury.

  • Consider occipital headache as a sign of VAD. Occipital headache lacks features that traditionally indicate a serious etiology. Headaches associated with VAD lack a thunderclap onset, are not associated with meningismus or fever, and are not associated with a history of significant head trauma.

  • Consider etiologies of the stroke syndrome, other than atherosclerosis, if the patient presents with brainstem or cerebellar dysfunction. This is especially true in the context of a negative CT scan and/or LP.

Differential Diagnoses