Which of the following is NOT one of the "N" signs of a possible VAD?

• A. Nausea
• B. Numbness
• C. Nystagmus
• D. Neck pain

Answer: (D)

Vertebral artery dissection (VAD) can present with various clinical signs that may suggest a compromise to the vertebral artery, and the mnemonic commonly used in clinical practice includes signs typically starting with "N." The signs, often referred to as the "N" signs, include nausea, numbness, nystagmus, and neurological deficits (not directly included in the options, but closely related to these signs).

Neck pain, while it can be a symptom associated with VAD, is not one of the recognized "N" signs. Its presence may suggest other cervical spine conditions or issues rather than specifically indicating VAD. In contrast, nausea can arise due to vestibular disturbances, numbness may indicate neurological involvement, and nystagmus suggests a potential involvement of the central nervous system affecting balance and eye movements. These signs are more directly correlated with the disruption of blood flow or neurological function associated with a vascular issue like VAD. Therefore, identifying neck pain as separate from this group highlights its distinction as not fitting within the "N" signs of concern when suspecting a vertebral artery dissection.