Spontaneous VAD is the term used to describe all cases
that do not involve blunt or penetrating trauma as a
precipitating factor. However, a history of trivial
or minor injury is elicited frequently from patients
with so-called spontaneous VAD. The diagnosis of traumatic
VAD is reserved for those patients with a history of
significant trauma, including motor vehicle accidents
(MVAs), falls, or penetrating injuries. Despite the
severity of the injury mechanism, dissections of the
vertebral artery are exceedingly rare in these contexts.
Several risk factors have been associated with the development
of VAD. These include the following:
Spinal manipulation - Has one of the best studied
and strongest demonstrated associations with VAD
Yoga
Ceiling painting
Nose blowing
Minor neck trauma
Judo
Medical risk factors
Hypertension (48% in one series)
Oral contraceptive use
Chronic headache syndromes/migraines
Intrinsic vascular pathology
Fibromuscular dysplasia
Cystic medial necrosis
Female sex
Recent infection
When patients with serious cervical trauma, such as
cord injuries or cervical spine fractures, are screened
for vertebral artery injury, 20-40% may demonstrate
traumatic occlusion. This traumatic vertebral artery
occlusion (as opposed to dissection) is asymptomatic,
and its management is controversial.
