Vertebral Artery Dissection (VAD) & Negligence

A vertebral artery dissection (VAD) is a tear in an artery at the back of the neck. It can cause a clot that blocks the basilar artery and triggers a brainstem stroke, the most common cause of locked-in syndrome. Your loved one remains aware. Families deserve to know whether neck manipulation, or the care that followed, played a role.

What Happens When a Vertebral Artery Tears

Two vertebral arteries run up the back of the neck, one on each side. Near the base of the skull, they meet and form the basilar artery.

Together, these vessels feed the brainstem. This small area controls movement, breathing, swallowing, and heart rate.

How the Tear Forms

An artery wall has layers. A dissection begins when the inner layer tears.

Blood slips into the tear and pools inside the wall between layers. As it pools, the blood can clot and/or the artery can swell and slow blood flow to the brain.

How a Tear Becomes a Stroke

The pooled blood can clot and disrupt the flow of blood. From there, the clot may:

• Block the artery where it formed
• Break loose and travel into the brain

When blood cannot reach the brainstem, brain cells begin to die. This is a stroke.

Why VAD Happens

Some dissections are spontaneous, with no clear injury. Others follow neck trauma, such as:

• A car crash
• A sports injury or fall
• A sudden twist or manipulation of the neck, such as during a chiropractic appointment

At first, symptoms may be mild. Neck pain or a headache can seem like nothing serious.

Why Timing Counts

Stroke risk is highest in the two weeks after a tear begins. A dissection caught early can often be treated before a stroke occurs.

When it goes unnoticed, the damage may progress beyond repair.

From Dissection to Basilar Artery Occlusion and Locked-in Syndrome

The two vertebral arteries merge into the basilar artery. This single vessel runs along the front of the brainstem and supplies much of it with blood.

A vertebral artery dissection can reach the basilar artery in two ways:

• The tear extends upward from the vertebral artery
• A clot breaks loose and lodges there

A blockage in this vessel is called a basilar artery occlusion. It is a rare type of stroke and one of the most serious.

What Happens to the Brainstem with a VAD and Stroke?

The brainstem carries signals between the brain and the body. A stroke here can damage those pathways.

When the damage reaches an area called the pons, the result can be locked-in syndrome. The person loses control of nearly all their muscles. Often, only eye movement or blinking remains.

Warning Signs That Are Easy to Miss

A dissection often begins with symptoms that seem minor, which is part of what makes it dangerous. Watch for:

• New neck pain, often on one side
• A sudden or unusual headache
• Dizziness or a spinning feeling
• Nausea or vomiting
• Double or blurred vision
• Trouble with balance or walking
• Slurred speech
• Numbness or weakness in the face

Many of these symptoms look like common problems. Dizziness can pass for vertigo, and a headache can pass for a migraine or a standard tension headache. After a neck adjustment, soreness or lightheadedness may be mistaken for a normal reaction.

Symptoms can appear during an appointment. They can also develop hours or days later, which makes the connection harder to see.

The BE FAST checklist can help families recognize a stroke:

• Balance: sudden dizziness or trouble walking
• Eyes: blurred or double vision
• Face: drooping or an uneven smile
• Arms: weakness or numbness
• Speech: slurred words or confusion
• Time: call 911 right away

If these signs appear after a neck injury or manipulation, tell every clinician involved about that history.

Were You a Victim of Medical Negligence?

If a delayed diagnosis led to permanent harm, you may be entitled to compensation. Speak with our legal team today.

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Where Negligence Can Occur

Responsibility may rest with the person who performed the manipulation, the clinicians who saw the patient afterward, or both. A careful review looks at each stage:

• Before treatment: Was the neck manipulated despite red-flag symptoms, or without a discussion of the risks?
• At the appointment: Were dizziness, pain, or vision changes dismissed instead of prompting emergency care?
• In the emergency department: Was stroke considered? Were the right scans ordered and read correctly? Was the care team told about the recent neck manipulation?
• During treatment: Did delays close the door on care that could have helped?

Speed shapes outcomes. The ATTENTION trial, published in the New England Journal of Medicine, studied patients with basilar artery occlusion. Among those who received thrombectomy within 12 hours, 46% were able to walk without assistance three months later. Only about 23% of those treated with medication alone reached the same outcome.

Jonathan’s Story

In 2015, Jonathan was a young, active man in Georgia. For several days, he had lived with neck pain, headaches, blurred vision, and ringing in his ears. He went to a chiropractor for relief, and during a neck adjustment, he experienced seizure-like activity and became unresponsive.

He was rushed to an emergency department, where imaging showed a stroke in his brainstem. His legal team later described a series of missed connections. The emergency physician did not tell the consulting neurologist about the neck adjustment. Test results were not clearly shared. Signs of a VAD were dismissed. On imaging, a blockage in the vertebrobasilar artery went unrecognized. Diagnosis and treatment did not come until the next day.

Jonathan developed locked-in syndrome. His mind remained fully aware, but he lost nearly all movement except in his eyes.

In 2022, a jury returned a $75 million verdict against the emergency physician and the radiologist.

(Read the whole story and more in our new e-book.)

How Families Can Seek Clarity

Questions about what happened can surface weeks or months later. You can gather the facts at your own pace, without committing to any next step.

• Write down your timeline. Note the appointment, when symptoms began, who you called, and what each clinician said. Details fade quickly in a crisis.
• Request all records. Ask for chiropractic or therapy notes along with hospital charts, test results, and imaging. You have the right to copies.
• Keep everything together. Save discharge papers, bills, and messages in one place.
• Ask for an independent review. A locked-in syndrome attorney experienced in medical cases can consult physicians who can assess whether the standard of care was met.

A review often brings clarity either way. Some families learn their loved one received appropriate care. Others learn that a missed sign changed the outcome. Whatever you decide afterward, the choice remains yours.

Finding Answers, Together

A vertebral artery dissection can change a family’s life in a single afternoon. In the weeks that follow, you may carry questions alongside the daily work of care: what happened, whether it could have been prevented, and how to plan for what lies ahead.

Through all of it, your loved one remains present. They hear your voice, understand your words, and feel your care.

When you are ready, Newsome Law can listen to your story and help you understand your options. There is no obligation and no pressure, only a conversation about what happened and what comes next.

Read more about Rich Newsome

Rich Newsome

Catastrophic Injury Locked-In Syndrome Attorney

Rich Newsome is a dedicated attorney specializing in catastrophic injury and medical malpractice cases. With over 25 years of experience, she is committed to advocating for victims and their families, ensuring they receive the justice and compensation they deserve.