Pediatric vertebral artery dissection and ischemic stroke following chiropractic manipulation

Pediatric vertebral artery dissection (VAD) following chiropractic cervical manipulation (CCM) is a rare phenomenon. As chiropractic care of pediatric populations increases internationally, it is imperative to increase awareness of this cause of VAD. The patient encountered in our institution was a 20-month-old male who presented nonspecifically with acute onset of lethargy, vomiting, cyanosis, and respiratory distress. Cerebrovascular imaging revealed a luminal irregularity in the V4 segment of the right vertebral artery, consistent with dissection. The patient's guardian later provided history of taking the child for cervical chiropractic corrections immediately prior to the patient's presentation to the emergency department. The patient was managed non operatively and was later discharged without neurological deficit. Non-specific presentations were also noted in the other two cases described in the literature. Appropriate diagnosis of pediatric VAD requires increased surveillance in response to a thorough history and an acknowledgment of the plethora of possible patient presentations and etiologies.