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Vertebrobasilar ischemia after cervical spine manipulation: a case report
D Tinel1, E Bliznakova, C Juhel
1Service de MPR, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France. damienne@tinel.be
Summary
Cervical spine manipulation can lead to serious vertebrobasilar ischemia accidents, often underestimated. Adhering to contraindications and proper practice significantly reduces risks, preventing severe neurological deficits.
Area of Science:
- Neurology
- Vascular Surgery
- Osteopathic Medicine
Background:
- Cervical spine manipulation is associated with vertebrobasilar ischemia, a serious complication whose incidence may be underestimated.
- Adherence to contraindications and proper technique can mitigate the risk of such adverse events.
Observation:
- A 39-year-old female with a history of migraines experienced neck pain treated with cervical manipulation.
- Seven hours post-manipulation, she developed Wallenberg's syndrome, indicative of brainstem or cerebellar involvement.
- Arteriography revealed basilar artery thrombosis and left vertebral artery dissection.
Findings:
- The patient presented with multiple neurological deficits including sensory-motor impairment, cerebellar signs, pyramidal tract signs, and cranial nerve palsies.
- Delayed diagnosis and treatment initiation (6.5 hours post-symptom onset) precluded intravenous thrombolysis.
- Despite eight months of rehabilitation, significant neurological sequelae persisted, including paralysis and cranial nerve deficits.
Implications:
- This case highlights the critical importance of recognizing contraindications, such as unusual occipital headaches, before cervical manipulation.
- Strict adherence to medical examinations and established practice guidelines is crucial to prevent severe accidents.
- Delayed diagnosis and treatment significantly impact patient outcomes, underscoring the need for prompt recognition and management of cerebrovascular events following manipulation.