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

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.  Citation: Daryl Irving Smith, Svetlana Pyatigorskya, Nobuyuki-Hai Tran. Delay in diagnosis of vertebrobasilar insufficiency: the masking effect of headache and coexisting pain syndromes. J Anesth Perioper Med 2017; 4: 231-6. doi:10.24015/JAPM.2017.0019This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.