Abrupt change in head position and cerebral infarction

Area of Science:

• Neurology
• Vascular Surgery
• Anatomy

Background:

• Cervical manipulation and head turning are common activities.
• Vertebral artery dissection is a rare but serious complication.
• Understanding the mechanism of injury is critical for prevention and treatment.

Observation:

• Eight patients presented with infarctions in the vertebral-basilar artery system.
• These events followed chiropractic neck manipulation or spontaneous head turning.
• Angiographic and autopsy findings revealed vertebral artery injury at the atlantoaxial joint.

Findings:

• Intimal injury of the vertebral artery serves as a nidus for thrombus formation.
• Thrombus propagation or embolization can affect the vertebral-basilar system.
• Progressive brainstem infarction results from compromised blood flow.

Implications:

• Highlights a potential risk associated with cervical manipulation.
• Emphasizes the importance of recognizing vertebral artery dissection.
• Suggests a potential role for anticoagulation in managing these cases.