Cervical Manipulation Leading to Cerebellar Stroke in a Pilot

Stroke is a decidedly devastating event for any patient, but particularly for a military aviator in a single-seat aircraft. Incidence of acute ischemic infarct in men ages 25 to 29 ranges from 3.4 to 5.6/100,000. The neurological sequelae of stroke can have a lasting and profound impact on an aviator's career. Literature review revealed a relatively small number of cases where stroke was attributable to cervical manipulation.

A 29-yr-old male jet pilot with a 2-wk history of cervicalgia following a mountain bike ride performed self-manipulation of his neck at home following a visit to a chiropractor. He sustained an immediate onset of euphoria, nausea, dysarthria, vertigo, diploplia, and occipital headache, and was transported via ambulance to the nearest emergency department. The patient's MRI/MRA imaging revealed a dissection of his right vertebral artery, as well as bilateral cerebellar infarcts. During the course of the following months, the patient's residual symptoms included neck pain, headaches, disequilibrium, and quadrantanopia.

The ability to recognize the symptoms of stroke and seek treatment in a timely manner are paramount and can drastically reduce the potential for permanent deficit. The evaluation of residual sequelae in military aviators who fly single-seat aircraft is of particular interest to aerospace medicine physicians when it comes time to return a pilot to flight duties. Additionally, the link between cervical manipulation and vertebral artery dissection leading to stroke remains equivocal, and further research is warranted.