CAROTID ARTERY DISSECTION FOLLOWING CERVICAL SPINE MANIPULATION: AN ASSOCIATION OR CAUSATIVE RELATIONSHIP

Abstract

TYPE: Late Breaking Case Report TOPIC: Cardiovascular Disease INTRODUCTION: Spinal manipulation is a hallmark practice of chiropractic providers and sometimes by physiotherapists, and osteopaths. It is a controversial and potentially dangerous procedure.1 Associations have been observed between chiropractic maneuvers and cervical artery dissection, although it remains difficult to prove causal relationship.2-4 We report a case of carotid artery dissection following chiropractic manipulation in a young male with no risk factors for carotid artery dissection. CASE PRESENTATION: This is a 40-year-old male with medical history of migraine headaches and cervicalgia, evaluated for a sudden onset of headache, associated with nausea, vomiting, blurred vision, and dizziness, two months after a chiropractic manipulation. He also reported rigorous exercise and sexual intercourse prior to the headache onset. Vital sign is significant for a 10/10, non-radiating right-sided headache. Neurological examination revealed right ptosis and miosis. Labs were unremarkable. CTA of neck showed tapering of the right ICA with near occlusion at the skull base. He was started on acetylsalicylic acid and clopidogrel, and subsequently discharged home to follow-up with Neurologist. Six-month follow-up revealed resolution of his symptoms and resolved right ICA dissection thrombosis. DISCUSSION: Spinal manipulation is commonly practiced by chiropractic and other providers. Even though it remains difficult to prove causal relationship between spinal manipulation and carotid artery dissection, several cases have been reported in the literature. Potential consequence of cervical artery dissection is stroke, which have increased morbidity and mortality.5 CONCLUSIONS: Our case highlights the dangers of chiropractic manipulation and provides a thorough review of the literature relating to chiropractic manipulation and carotid artery dissection. DISCLOSURE: Nothing to declare. KEYWORD: Cervical spine manipulation