Neck manipulation causing stroke. Case reports

Neck manipulation may cause injury to the vertebrobasilar arterial system with resultant brainstem ischaemia or infarction. This complication has been recognized for many years, and although rarely reported in the literature is a well-recognized problem encountered by neurologists. This article describes 3 patients with this condition seen at the Johannesburg Hospital. The probable pathogenesis is that a thrombus occurs at a site of vertebral artery injury created by sudden sharp neck movement chiefly between the axis and atlas. This thrombus may propagate or embolize. The therapeutic role of anticoagulants is discussed.