Iatrogenic Vertebral Artery Dissection with Posterior Fossa and Lateral Medullary Stroke After Uncomplicated Cervical Nerve Ablation

Abstract

BackgroundA cervical radiofrequency ablation is a procedure that can be performed to treat arthritis-related pain in the neck and upper back. There have been no large studies reporting complications after this procedure. We report a case of a 55-year-old woman with iatrogenic vertebral artery dissection of C3–C4 with segmental occlusion leading to a posterior fossa stroke and lateral medullary stroke after a high-grade cervical nerve ablation. Case ReportA 55-year-old woman presented to the Emergency Department with vomiting, neck pain, temperature changes, dizziness, and dysarthria after undergoing C2–C3, C4–C5 nerve ablation 30 min prior to arrival. The patient was found to have a vertebral artery dissection with posterior fossa and lateral medullary stroke. Why Should an Emergency Physician Be Aware of This?Vertebral artery dissection and subsequent stroke should be considered with recent cervical facet joint injections, such as intra-articular facet joint injections, medial branch blocks, or medial branch radiofrequency nerve ablation. The case we report shows devastating outcomes that can result from what many consider a relatively simple procedure.