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By Jorge L. Flores, Esq. | Florida Bar #53244 | AV Preeminent Rated | Martindale & Avvo 2024 Top Rated Lawyer | FindLaw Rated 30+ Years Experience
Member, Florida Justice Association | Member, American Association for Justice
Medical Emergency: If you or someone you know is experiencing sudden severe neck pain or headache, especially after chiropractic adjustment or neck trauma, along with dizziness, vision changes, difficulty swallowing, or one-sided weakness, call 911 immediately. Vertebral artery dissection requires urgent treatment to prevent stroke.
Vertebral Artery Dissection occurs when a tear develops in the inner lining of the vertebral artery, allowing blood to enter the vessel wall and form a clot that can travel to the brain and cause a stroke. The Miami medical malpractice attorneys at The Law Offices of Jorge L. Flores, P.A. represent victims and families throughout Florida who have suffered catastrophic stroke injury due to chiropractic manipulation negligence, failure to diagnose dissection symptoms, and delayed treatment that allowed a preventable stroke to occur.
For over 30 years, our firm has investigated complex stroke malpractice cases against chiropractors, emergency rooms, Baptist Health South Florida, Jackson Memorial Hospital, HCA Florida Kendall Hospital, and other healthcare providers throughout Miami-Dade County. We work with board-certified neurologists, neuroradiologists, and vascular specialists to prove that healthcare providers failed to recognize the warning signs of vertebral artery dissection. VAD is frequently misdiagnosed as tension headache, migraine, or musculoskeletal neck pain. These diagnostic errors cost patients the critical treatment window where anticoagulation can prevent stroke.
Unlike high-volume settlement firms, The Law Offices of Jorge L. Flores, P.A. prepares every vertebral artery dissection case as if it will reach a courtroom and jury. We understand the complex anatomy of the cervical vertebral arteries and the biomechanics of how chiropractic manipulation can cause arterial injury. We know how to prove that earlier diagnosis would have prevented permanent brain damage. Call (305) 598-2221 today to schedule a free consultation with a Miami VAD malpractice attorney who understands these complex cases.
What is Vertebral Artery Dissection?
Vertebral Artery Dissection is a tear in the inner lining of the vertebral artery, one of the major blood vessels that supplies the back of the brain. The vertebral arteries are paired vessels that travel through the cervical spine before joining to form the basilar artery. They supply blood to the brainstem, cerebellum, and posterior portions of the brain. When the inner lining tears, blood forces its way between the layers of the arterial wall. This creates a dangerous situation that can lead to stroke.
The arterial wall consists of three layers: the intima, the media, and the adventitia. Think of these as the lining, the muscle, and the outer covering. A dissection occurs when a tear develops in the intima, the inner lining. High-pressure blood then forces its way between the layers, creating what doctors call a false lumen. This has two dangerous consequences. First, the expanding pocket of blood can narrow or completely block the true channel, reducing blood flow to the brain. Second, the body forms a clot at the injury site. If a piece of this clot breaks off and travels to the brain, it causes an ischemic stroke.
The vertebral artery is divided into four segments, labeled V1 through V4. The V3 segment, known as the atlas loop, is the most vulnerable to injury during neck manipulation. This segment winds around the atlas vertebra at the top of the spine. During head rotation, the V3 segment must stretch to accommodate the movement. The C1-C2 joint allows approximately 50% of the entire cervical spine’s rotation. High-velocity rotational manipulation places immense stress on this segment, potentially stretching the artery beyond its limits and causing a tear.
VAD affects a different population than typical strokes. While most strokes occur in elderly patients with vascular risk factors, vertebral artery dissection often affects young, otherwise healthy adults. The average age of VAD patients is between 40 and 45 years old. Risk factors include chiropractic manipulation, trauma, connective tissue disorders, and certain neck positions maintained for prolonged periods. Because doctors do not expect to see stroke in young patients, VAD is frequently misdiagnosed.
Causes of Vertebral Artery Dissection
Chiropractic Cervical Manipulation: The procedure most often implicated in VAD litigation is the high-velocity, low-amplitude thrust directed at the cervical spine. This is the quick twisting motion that produces a cracking sound. This maneuver involves rapid rotation and extension of the neck. While most adjustments are performed without incident, the biomechanics of cervical manipulation place direct stress on the V3 segment of the vertebral artery. A 2001 study published in Neurology found that patients under age 45 who had a stroke were five times more likely to have visited a chiropractor in the preceding week than control patients (Smith et al., Neurology 2001;57:1529-1535). When a chiropractor fails to screen for risk factors, uses excessive force, or ignores post-adjustment symptoms like dizziness or neck pain, the result can be catastrophic stroke.
Beauty Parlor Stroke Syndrome: A less common but legally actionable cause of VAD is hyperextension of the neck over a shampoo basin at a hair salon. When the neck is hyperextended backward for a prolonged period, the vertebral arteries can be compressed against the cervical vertebrae. This compression can damage the arterial lining or cause blood flow stasis that promotes clotting. This scenario presents a premises liability or general negligence claim against the salon for failure to provide adequate neck support.
Trauma and Motor Vehicle Accidents: Blunt trauma to the neck, including whiplash injuries from car accidents, can cause vertebral artery dissection. The sudden hyperextension and rotation of the neck during a collision can tear the arterial lining. These cases may involve both personal injury claims against the at-fault driver and medical malpractice claims if the emergency room fails to diagnose the dissection.
Bow Hunter’s Syndrome: This condition involves mechanical compression of the vertebral artery that occurs only when the head is rotated to a certain position. Patients experience transient symptoms such as dizziness or loss of consciousness when turning their head, but symptoms resolve when the head returns to neutral. Because standard imaging is performed with the head in neutral position, the compression may not be visible. The failure to order dynamic imaging with the head rotated in a patient with position-dependent symptoms is a deviation from the standard of care.
How Vertebral Artery Dissection is Misdiagnosed
The most common presenting symptom of vertebral artery dissection is headache or neck pain, occurring in up to 88% of cases. This pain is often described as sudden, severe, and unlike any pain the patient has experienced before. Medical literature calls this a thunderclap headache. The pain is typically located in the back of the head or upper neck. In our experience handling over 50 stroke malpractice cases in Miami-Dade County, we have seen emergency physicians dismiss this pain as tension headache, migraine, or musculoskeletal strain. This is a dangerous diagnostic error.
The classic clinical presentation of VAD involves a triad of symptoms. First, severe headache or neck pain, especially in the back of the head. Second, Horner’s syndrome, which includes drooping eyelid, constricted pupil, and decreased sweating on one side of the face. Third, signs of posterior circulation stroke such as dizziness, vertigo, double vision, difficulty swallowing, slurred speech, or loss of balance. The presence of a painful Horner’s syndrome is considered highly specific for arterial dissection. Failure to investigate this combination is a clear breach of the standard of care.
The malpractice pattern in VAD cases follows a predictable sequence. The patient visits a chiropractor for neck pain or headache. The chiropractor performs a cervical adjustment. The patient develops dizziness, severe headache, or neck pain after the adjustment. The chiropractor dismisses these symptoms or sends the patient home. Hours or days later, a clot formed at the dissection site breaks off and travels to the brain. The patient suffers a devastating stroke.
In emergency room cases, the failure typically involves imaging selection. A standard CT scan of the head may appear normal in a patient with VAD who has not yet suffered a completed stroke. In Florida, the standard of care requires CT Angiography when a patient presents with severe neck pain or headache following trauma or manipulation, especially with any neurological symptoms. CTA can directly visualize the arterial narrowing, occlusion, or the characteristic string sign associated with dissection. Stopping at a normal head CT when clinical suspicion remains high is a breach of the standard of care.
Wallenberg Syndrome: A Devastating Consequence of VAD
Wallenberg Syndrome, also known as Lateral Medullary Syndrome, is a specific and devastating consequence of vertebral artery dissection. It results from a stroke affecting the lateral medulla in the brainstem. This area is supplied by the Posterior Inferior Cerebellar Artery, known as PICA, which branches from the vertebral artery. When VAD causes a clot to travel to PICA or reduces blood flow to this region, Wallenberg Syndrome occurs.
Victims of Wallenberg Syndrome experience severe and often permanent symptoms. The effects can be life-altering. These include severe vertigo, difficulty swallowing that often requires a feeding tube, hoarseness, violent hiccups, and a unique pattern of sensory loss. Patients lose pain and temperature sensation on one side of the face and the opposite side of the body. Many patients are left with permanent gait instability and swallowing difficulties that require lifelong care. In Florida, the Life Care Plan for a Wallenberg Syndrome patient can reach several million dollars for future therapy, nursing care, and medical equipment.
Types of Vertebral Artery Dissection Cases We Handle
Every vertebral artery dissection case The Law Offices of Jorge L. Flores, P.A. investigates is analyzed by board-certified neurologists, neuroradiologists, and vascular specialists to determine whether the claim meets Florida’s threshold requirements.
The Law Offices of Jorge L. Flores, P.A. handles VAD cases including chiropractic manipulation stroke, failure to diagnose dissection in the emergency room, missed Horner’s syndrome, delayed CT angiography, and stroke following neck trauma. Our Miami medical malpractice attorneys investigate all forms of negligence that result in preventable vertebral artery dissection injury.
Complete list of case types we handle:
- Chiropractic Manipulation Stroke
- High-Velocity Low-Amplitude (HVLA) Cervical Adjustment Injury
- Cervical Artery Dissection from Neck Manipulation
- Beauty Parlor Stroke Syndrome
- Vertebral Artery Dissection from Car Accident
- Whiplash-Related Arterial Dissection
- Sports Injury Vertebral Artery Dissection
- Bow Hunter’s Syndrome Misdiagnosis
- Failure to Diagnose VAD in Emergency Room
- Thunderclap Headache Discharged Without Imaging
- Missed Horner’s Syndrome
- Failure to Order CT Angiography
- Missed String Sign on Imaging
- Delayed Anticoagulation Treatment
- VAD Misdiagnosed as Migraine
- VAD Misdiagnosed as Tension Headache
- VAD Misdiagnosed as Musculoskeletal Pain
- Post-Chiropractic Symptoms Ignored
- Wallenberg Syndrome from VAD
- Lateral Medullary Infarction
- PICA Stroke from Vertebral Artery Dissection
- Posterior Circulation Stroke from VAD
- Basilar Artery Thrombosis from VAD
- Connective Tissue Disorder VAD
- Ehlers-Danlos Syndrome Stroke
- Vertebral Artery Dissection Wrongful Death
Chiropractic Malpractice and Vertebral Artery Dissection
Chiropractic malpractice claims involving vertebral artery dissection require proof that the chiropractor breached the standard of care. This breach typically manifests in one of three ways.
Failure to Screen for Risk Factors: Chiropractors have a duty to review a patient’s medical history before performing cervical manipulation. Risk factors for VAD include prior stroke, blood clotting disorders, connective tissue diseases like Ehlers-Danlos syndrome or Marfan syndrome, hypertension, and smoking. Performing high-velocity cervical manipulation on a patient with these risk factors without proper evaluation is a deviation from the standard of care.
Improper Technique: The application of excessive rotational force during cervical manipulation can tear the vertebral artery. While the force required to cause dissection varies among patients, particularly those with underlying vascular abnormalities, the standard of care requires chiropractors to use appropriate technique and force levels. Expert testimony from other chiropractors or biomechanical engineers can establish whether the manipulation exceeded acceptable parameters.
Failure to Recognize Post-Adjustment Symptoms: If a patient complains of dizziness, vertigo, severe headache, or nausea immediately following a cervical adjustment, the standard of care requires the chiropractor to stop treatment and refer the patient for emergency evaluation. Ignoring these warning signs and sending the patient home constitutes negligence. We’ve seen chiropractors tell patients that dizziness is a normal response to adjustment. It is not. These symptoms may indicate vertebral artery injury requiring immediate medical attention.
Proving Vertebral Artery Dissection Malpractice in Florida
In Florida, medical malpractice law requires plaintiffs to establish four elements. First, the healthcare provider owed a duty of care. Second, the provider breached the accepted standard of care. Third, this breach was the proximate cause of the injury. Fourth, the patient suffered damages as a result.
Causation is often the most contested element in VAD cases. Defense attorneys frequently argue that the dissection was spontaneous and unrelated to the chiropractic manipulation or that the stroke would have occurred regardless of the diagnostic delay. In Florida, the plaintiff must prove that the negligence was a substantial factor in causing the injury. This does not require proving the negligence was the only cause, but that it materially contributed to the harm. In VAD cases, we use neurology experts to establish that timely diagnosis and anticoagulation would have prevented the clot from embolizing to the brain.
Florida Statute §766.102 establishes that the standard of care is defined by what a reasonably prudent healthcare provider with similar training would have done under the same circumstances. In Florida, the standard of care requires chiropractors to screen patients for VAD risk factors, use appropriate manipulation techniques, and recognize post-adjustment symptoms that may indicate arterial injury. For emergency physicians, the standard requires consideration of VAD when a patient presents with sudden severe neck pain or headache, especially with neurological symptoms or recent neck trauma.
Before filing a medical malpractice lawsuit in Florida, the law requires a pre-suit investigation period. Florida Statute §766.106 mandates that the plaintiff’s attorney send a Notice of Intent to Initiate Litigation. Both sides then conduct a 90-day investigation during which medical records are exchanged and expert opinions are obtained. Florida Statute §766.203 requires a medical expert to provide a verified written opinion that the standard of care was breached before the lawsuit can proceed. In a VAD case involving both a chiropractor and an emergency room, you may need separate experts in chiropractic medicine, emergency medicine, and neurology.
In Florida, there is a two-year statute of limitations for medical malpractice claims under Florida Statute §95.11(4)(b). This runs from the date the injury was discovered or should have been discovered through reasonable diligence. A four-year statute of repose provides an absolute deadline regardless of discovery. If you believe your loved one suffered a preventable stroke from vertebral artery dissection, contacting an attorney promptly protects your right to pursue compensation.
Damages in Vertebral Artery Dissection Cases
In Florida, the Supreme Court declared damage caps in medical malpractice cases unconstitutional in 2017. Juries can now award full compensation for the actual losses suffered by VAD victims. There are no artificial limits. In Florida, because VAD often affects young, otherwise healthy adults in their 30s and 40s, the economic damages for lost earning capacity can be substantial.
VAD strokes can cause a wide range of permanent injuries including paralysis, vision loss, difficulty swallowing, chronic vertigo, cognitive impairment, and death. Survivors may require feeding tubes, speech therapy, physical rehabilitation, and assistance with daily activities for the remainder of their lives. A Life Care Plan prepared by specialized experts details every medical need the patient will have. For young stroke victims with Wallenberg Syndrome or other permanent deficits, lifetime care costs can reach millions of dollars.
In Florida, VAD victims can recover economic damages for medical expenses, lifetime care costs, and lost earning capacity, as well as non-economic damages for pain and suffering without damage caps. Young stroke survivors face 30 or more years of lost wages and career advancement. Vocational economists calculate the present value of these losses. Even patients with good physical recovery may suffer invisible disabilities such as fatigue, cognitive slowing, and executive dysfunction that prevent return to competitive employment.
Family members may recover loss of consortium damages for the destruction of the marital or familial relationship. Spouses lose the companionship, affection, and intimacy of their partner. Children lose the guidance and active participation of their parent. These relational losses are compensable under Florida law.
Our Stroke and Vertebral Artery Dissection Case Results
Confidential Settlement: Chiropractic Manipulation Stroke. A 38-year-old patient visited a chiropractor for neck stiffness. Following a high-velocity cervical adjustment, she experienced immediate dizziness and severe headache. The chiropractor told her these symptoms were normal and sent her home. Two days later, she suffered a massive posterior circulation stroke from vertebral artery dissection. Our investigation revealed the chiropractor failed to recognize warning signs of arterial injury and failed to refer for emergency evaluation. The settlement provided for her lifetime care needs including physical therapy, occupational therapy, and assistance with daily living activities.
Confidential Multi-Million Dollar Settlement: Brainstem Stroke Misdiagnosed as Vertigo. A 52-year-old patient was sent home from the emergency room with an inner ear infection diagnosis after presenting with severe dizziness. The ER physician relied on a negative CT scan and failed to perform appropriate vascular imaging. Six hours later, the patient returned with catastrophic injury. Our investigation revealed missed findings on the original imaging. The settlement provided lifetime nursing care and secured the family’s financial future.
$9.2 Million Verdict: Sepsis Malpractice. For a patient whose hospital had six separate opportunities to diagnose and treat a life-threatening condition but repeatedly chose less aggressive treatment options. This verdict demonstrates our ability to prove systemic failures in hospital care through detailed timeline analysis and expert testimony.
Past results do not guarantee a similar outcome. Each case is unique and must be evaluated on its own merits.
Why Choose The Law Offices of Jorge L. Flores, P.A. for Your VAD Case
Vertebral artery dissection cases require an attorney who understands both the complex anatomy of the cervical vasculature and the biomechanics of how manipulation or trauma can cause arterial injury. Attorney Jorge L. Flores brings a unique triple perspective to medical malpractice litigation. He gained experience as a former prosecutor. He spent years working as an insurance defense attorney at a top-rated Miami defense firm. For over 30 years, he has represented injured victims as a plaintiff’s advocate. He holds an AV Preeminent rating from Martindale-Hubbell, placing him in the top 5% of attorneys for legal ability and ethics. Attorney Flores has presented on stroke malpractice litigation at the Florida Justice Association annual conference.
This background means we understand how chiropractors, hospitals, and their insurers attempt to escape liability. We know the defense playbook because we helped write it. When defense counsel argues that the dissection was spontaneous, we have neurology experts ready to explain the biomechanical connection between manipulation and arterial injury. When they claim the symptoms were too vague to diagnose, we have emergency medicine experts prepared to explain why vascular imaging should have been ordered.
The Law Offices of Jorge L. Flores, P.A. has handled stroke malpractice cases against healthcare providers throughout Miami-Dade County, including Baptist Health South Florida, Jackson Memorial Hospital, and HCA Florida Kendall Hospital. We maintain relationships with board-certified neurologists, neuroradiologists, vascular specialists, and life care planners. These experts provide the testimony necessary to prove complex VAD cases.
We limit our caseload so every client receives personalized attention from Attorney Flores directly. You will not be passed off to a paralegal or junior associate. Our firm operates on a contingency fee basis, meaning you pay no attorney fees unless we recover compensation for your family.
We understand the cultural dynamics of Miami’s diverse communities and provide complete legal services in English, Spanish, and Portuguese. When your family is facing the overwhelming challenge of caring for a loved one with a stroke from vertebral artery dissection, you deserve an attorney who treats you like family while fighting aggressively to secure the resources needed for lifetime care.
Frequently Asked Questions About Vertebral Artery Dissection Malpractice
Can I sue a chiropractor if I had a stroke after a neck adjustment?
In Florida, you may have a malpractice claim if the chiropractor failed to screen for risk factors, used improper technique, or ignored warning symptoms after the adjustment. The standard of care requires chiropractors to recognize that dizziness, severe headache, or neck pain following cervical manipulation may indicate vertebral artery injury requiring immediate medical evaluation.
What is the connection between chiropractic adjustment and stroke?
High-velocity cervical manipulation places stress on the V3 segment of the vertebral artery as it winds around the atlas vertebra. This stress can tear the inner lining of the artery, causing a dissection. A clot forms at the injury site and may later break off and travel to the brain, causing a stroke. The delay between manipulation and stroke can range from minutes to several days.
How long do I have to file a vertebral artery dissection lawsuit in Florida?
In Florida, there is a two-year statute of limitations from discovery of the injury and a four-year statute of repose from the date of the incident. Given these strict deadlines and the extensive pre-suit investigation required by Florida law, you should consult with an attorney as soon as you suspect malpractice occurred.
What is Horner’s syndrome and why is it important in VAD cases?
Horner’s syndrome is a combination of drooping eyelid, constricted pupil, and decreased sweating on one side of the face. It results from damage to the sympathetic nerve fibers that run along the arterial wall. The presence of a painful Horner’s syndrome with headache or neck pain is considered highly specific for arterial dissection. Failure to investigate this combination is a clear breach of the standard of care.
Can I sue the emergency room if they missed my vertebral artery dissection?
In Florida, emergency room physicians may be liable if they failed to consider VAD in a patient with severe neck pain or headache, especially following trauma or manipulation. The standard of care requires CT Angiography when clinical suspicion is high. A normal head CT does not rule out VAD. Stopping at a negative CT when symptoms suggest arterial injury is a deviation from the standard of care.
What is Wallenberg Syndrome?
Wallenberg Syndrome, or Lateral Medullary Syndrome, is a specific type of stroke affecting the brainstem caused by blockage of the Posterior Inferior Cerebellar Artery. It causes severe vertigo, difficulty swallowing, hoarseness, and a unique pattern of sensory loss. Many patients are left with permanent disabilities requiring lifelong care. The Life Care Plan for Wallenberg Syndrome patients can reach millions of dollars.
What is Beauty Parlor Stroke Syndrome?
Beauty Parlor Stroke Syndrome occurs when hyperextension of the neck over a shampoo basin compresses the vertebral arteries and causes dissection or blood flow stasis leading to clot formation. This can form the basis of a premises liability or negligence claim against the salon for failure to provide adequate neck support, particularly for older clients or those with vascular risk factors.
Why wasn’t my vertebral artery dissection diagnosed sooner?
VAD is frequently misdiagnosed because it affects young patients who do not fit the typical stroke profile, and its symptoms overlap with common conditions like migraine and tension headache. A standard head CT may appear normal because VAD affects the blood vessels, not the brain tissue. Diagnosis requires vascular imaging such as CT Angiography or MR Angiography to visualize the arterial injury directly.
Can I file a lawsuit if my family member died from vertebral artery dissection stroke?
In Florida, wrongful death law allows surviving family members to pursue claims for medical expenses, funeral costs, lost financial support, and loss of companionship. The same two-year statute of limitations applies. The Law Offices of Jorge L. Flores, P.A. handles wrongful death claims arising from chiropractic malpractice and failure to diagnose vertebral artery dissection.
How much does it cost to hire a vertebral artery dissection malpractice attorney?
The Law Offices of Jorge L. Flores, P.A. handles medical malpractice cases on a contingency fee basis. You pay no attorney fees unless we recover compensation for your family. We also advance the costs of medical experts, neurologists, and other expenses necessary to build your case. There is no financial risk to you.
Contact Our Miami Vertebral Artery Dissection Malpractice Attorneys
If your loved one suffered a stroke from vertebral artery dissection that was caused by chiropractic malpractice or misdiagnosed in an emergency room, The Law Offices of Jorge L. Flores, P.A. can help you understand your legal options. We offer free consultations to families throughout Florida who believe medical negligence contributed to their loved one’s catastrophic injury.
Call (305) 598-2221 today to speak with a Miami medical malpractice attorney who understands the complex anatomy of vertebral artery dissection and has the resources to prove your case. You can also visit our office at 7700 N Kendall Dr #708, Miami, Florida 33156.
Do not wait. Florida’s statute of limitations strictly limits the time you have to file a claim. Every day of delay is a day the evidence fades and your legal rights erode. Contact us now to schedule your free case evaluation.
The information on this page is for general informational purposes only and does not constitute legal advice.
Page reviewed and updated: January 2026
Medical content reviewed for accuracy by consulting neurologist.
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Who created this content: This page was written by Jorge L. Flores, P.A., Florida Bar Member 53244, and was reviewed by our legal team for accuracy and compliance with current Florida law. AV Preeminent® rating since 2015. Also Featured as top lawyer on FindLaw.
How this page was prepared: The content was developed based on 30+ years of medical malpractice case experience in Miami-Dade County, a review of current Florida statutes, and adherence to Florida Bar advertising guidelines. Medical standards referenced were verified with board certified physicians.
Why this page exists: To provide Florida residents with accurate, accessible information about their legal rights after medical negligence, and to explain the malpractice claims process in clear, understandable terms.
Last reviewed: 01 / 18 / 2026
Disclaimer: This content is for informational purposes regarding legal rights. It does not constitute medical or legal advice. Each case is unique. Results depend on the specific facts and law applicable to your situation. No attorney client relationship is formed until a fee agreement is signed.
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