Abstract
Chiropractic cervical manipulation is a common practice utilized around the world. Most patients are never cleared medically for manipulation, which can be devastating for those few who are at increased risk for dissections. The high velocity thrust used in cervical manipulation can produce significant strain on carotid and vertebral vessels. Once a dissection has occurred, the risk of thrombus formation, ischemic stroke, paralysis, and even death is drastically increased. In this case report, we highlight a case of a 32-year-old woman who underwent chiropractic manipulation and had vertebral artery dissection with subsequent brainstem infarct. She quickly deteriorated and passed away shortly after arrival to the hospital. Although rare, one in 48 chiropractors have experienced such an event. We utilize this case to highlight the risk associated with cervical manipulation and urge open dialogue between chiropractors and physicians. Receiving medical clearance prior to cervical manipulation in potential at risk patients would drastically reduce morbidity and mortality.
Highlights
Spinal manipulation, a hallmark practice of chiropractic providers and a practice occasionally utilized by physiotherapists, osteopaths, and physicians, is often viewed as a controversial and potentially dangerous procedure without good evidence supporting its use [1]
We report a case of vertebral artery dissection and subsequent brainstem infarction immediately following chiropractic manipulation in a young female patient
A study focused on malpractice data from the Canadian Chiropractic Protective Association (CCPA) showed a low incidence of neurological symptoms attributable to cervical manipulation and arterial dissection following chiropractic manipulation [35]
Summary
A hallmark practice of chiropractic providers and a practice occasionally utilized by physiotherapists, osteopaths, and physicians, is often viewed as a controversial and potentially dangerous procedure without good evidence supporting its use [1]. This patient experienced rapid deterioration immediately following manipulation and proceeded to undergo cardiac arrest prior to presentation to the hospital and subsequent death This case serves to highlight the potential dangers of chiropractic manipulation and provides a thorough review of the literature relating chiropractic manipulation and stroke. Upon arrival in the emergency department, a CT stroke protocol was performed which demonstrated bilateral severe distal cervical vertebral artery dissections with acute thrombotic emboli seen in the left cervical vertebral artery (Figures 1 and 2). This was accompanied by complete occlusion of the basilar tip including the proximal posterior cervical arteries. The following day, additional CT Brain imaging was acquired and demonstrated signs of elevation of intracranial pressure with hydrocephalus, worsening of cerebral edema diffusely, hemorrhagic transformation of the left occipital lobe, continued infarct evolution within the posterior circulation, and cerebellar tonsillar herniation
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