J Anesth Perioper Med. 2017;4(5):231-236. https://doi.org/10.24015/ebcmed.japm.2017.0019

Delay in Diagnosis of Vertebrobasilar Insufficiency: The Masking Effect of Headache and Coexisting Pain Syndromes

Daryl Irving Smith1, Svetlana Pyatigorskya2, and Nobuyuki-Hai Tran1

From 1Acute Pain Service, Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, USA; 2Pain Clinic, Canton-Potsdam Hospital, Potsdam, USA.

Correspondence to Dr. Daryl Irving Smith at Daryl_Smith@urmc.rochester.edu.

EBCMED ID: ebcmed.japm.2017.0019 DOI: 10.24015/ebcmed.japm.2017.0019


Headaches of vascular and other origins can develop in the midst of work-ups for benign, long-standing pain conditions. The initial attribution of these headaches to benign conditions in the early evaluative process, especially when non-life threatening signs and symptoms are present, is not only frequently plausible but most often correct. Given the frequency with which patients present with a complaint of headache, constant vigilance and re-examination is required to prevent potentially life-threatening conditions from being overlooked as they develop. This case report describes a patient presentation that should serve as a cautionary tale for such a circumstance. Common, concurrent maladies were diagnosed and treated with varying degrees of success, yet the evolution of a potentially life- threatening disease with very similar symptomatology occurred in the midst of the workup. We believe this description will prove of value to established clinicians in their everyday practices, as well as to trainees as they study differential diagnoses.

Article Type
Case Report

Declaration of Interests
The authors declare no potential conflicts of interest for this work.

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