Vertebral-basilar distribution infarction following chiropractic cervical manipulation

Area of Science:

• Neurology
• Vascular Medicine
• Chiropractic Medicine

Background:

• Previous reports linked vertebral-basilar system infarction after chiropractic manipulation to predisposing factors.
• Predisposing factors include cervical spondylosis, atherosclerosis, and congenital posterior circulation asymmetry.

Observation:

• Ten patients without prior neurological symptoms experienced vertebral-basilar system infarction shortly after chiropractic maneuvers.
• One patient, lacking predisposing factors, died and autopsy revealed bilateral vertebral artery thrombosis and brainstem infarction.
• Nine survivors presented with neurological deficits from posterior circulation lesions.

Findings:

• Chiropractic cervical manipulation is implicated as a potential trigger for vertebral-basilar system infarction.
• Bilateral vertebral artery thrombosis was identified as a cause of infarction in a fatal case.
• No patients received anticoagulant therapy.

Implications:

• Cervical manipulation may be a significant risk factor for stroke in susceptible individuals.
• Understanding the kinetic anatomy of vertebral arteries is crucial for assessing risks.
• Further research is needed to establish causality and refine patient selection for chiropractic care.