• Larkin-Thier SM
• Livdans-Forret A

• Association of Chiropractic Colleges / congresses

CLINICAL FEATURES: A 32-year-old female sought care for a constant headache of 4 days duration. She described the headache as severe throughout her entire head, centralized at the base of the occiput, and unlike any headache she had experienced in the past with accompanying neck pain. She also reported that approximately 12 hours after the onset of the headache her left eye deviated toward the midline. It was also tearing excessively. She appeared to be in acute distress, and the convergence of her left eye to the midline was quite notable. Her left pupil was fixed and dilated, with deviation to the midline. Assessment of vitals revealed blood pressure of 139/96, pulse 76 and regular and respiration rate of 16. The patient was overweight and a smoker. Her past history included a significant cervical acceleration/deceleration injury. The clinical presentation suggested that a cerebral vascular accident was a probable differential diagnosis.

INTERVENTION AND OUTCOME: With the strong probability that a cerebral vascular accident was likely, it was felt that her situation was potentially life threatening. Therefore, no chiropractic adjustment was administered. Instead, immediate transfer for emergency treatment was arranged. The emergency room was notified of her condition, vital signs and probable diagnosis of cerebral vascular accident. The diagnosis of a bleeding intracranial aneurysm was confirmed via MRI. She was transferred to a local university hospital for surgical intervention. Unfortunately, she died as result of vasospastic complications from the aneurysm.

CONCLUSION: The “red flags” to be considered in evaluating the patient include history of hypertension, cigarette smoking, oral contraceptive usage, alcohol consumption, pregnancy, and use of cocaine. Doctors of chiropractic need to be aware of the signs and symptoms that indicate that a headache may be due to more serious problems such as aneurysm.

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For more information about aneurysms see MedlinePlus.