[Vertebral artery dissection following manipulation of the cervical vertebrae]

We report on two patients who developed symptoms and signs of infarction of dorsolateral medulla oblongata (Wallenberg's syndrome) and the cerebellum respectively, following cervical manipulation for slight neck pain. Subsequent vertebral artery angiography and MRI showed the typical signs of vertebral artery dissection of the atlantoaxial and intracranial segment in one patient, and of the intertransverse segment in the second. The pathogenesis of vertebral artery injury following cervical manipulation is discussed and the literature is reviewed. The practical implications of this rare complication are discussed.