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Neck manipulation causing stroke. Case reports.

V U Fritz, A Maloon, P Tuch

    South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde
    |December 1, 1984
    PubMed
    Summary
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    Neck manipulation can injure the vertebrobasilar arteries, causing brainstem damage. This case series highlights vertebral artery injury and thrombus formation, discussing anticoagulant therapy for this rare neurological complication.

    Area of Science:

    • Neurology
    • Vascular Surgery
    • Neuroscience

    Background:

    • Neck manipulation, including chiropractic adjustments, is associated with potential injury to the vertebrobasilar arterial system.
    • Cerebrovascular complications such as brainstem ischemia or infarction are recognized risks, though rarely reported.
    • Neurologists frequently encounter this challenging clinical problem.

    Observation:

    • This article presents three cases of vertebrobasilar artery injury following neck manipulation treated at Johannesburg Hospital.
    • The patients experienced neurological deficits attributed to the arterial compromise.
    • Clinical presentation and diagnostic findings are detailed for each case.

    Findings:

    • A probable pathogenesis involves thrombus formation at the site of vertebral artery injury, typically between the axis and atlas, due to sudden neck movements.

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  • The thrombus can propagate or embolize, leading to reduced blood flow and ischemic events in the brainstem.
  • The study explores the potential role of anticoagulant therapy in managing this condition.

    • Implications:

    • Understanding the mechanism of injury is crucial for early diagnosis and intervention.
    • Prompt recognition and appropriate management, potentially including anticoagulation, may improve patient outcomes.
    • This highlights the importance of considering neck manipulation as a potential cause of stroke in relevant patient populations.