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Dissection of the internal carotid artery after chiropractic manipulation of the neck
Insights
Chiropractic neck manipulation may trigger internal carotid artery dissection in patients with underlying mediolytic arteriopathy, a rare vascular condition. This case highlights a potential link between neck manipulation and arterial dissection in susceptible individuals.
Area of Science:
- Vascular pathology
- Neurology
- Arterial diseases
Background:
- Cervical artery dissection is a known complication of neck manipulation.
- Mediolytic arteriopathy is a rare condition characterized by degeneration of the arterial wall.
Observation:
- A 29-year-old woman experienced a fatal right hemispheric infarction due to internal carotid artery dissection and thrombosis.
- The dissection occurred subsequent to chiropractic neck manipulation.
- Pathologic examination revealed mediolytic arteriopathy with mucoid degeneration and cystic transformation of the arterial wall.
Findings:
- The patient presented with a rare mediolytic arteriopathy, a condition involving degeneration of the tunica media in muscular and elastic arteries.
- This arteriopathy is hypothesized to have predisposed the patient to internal carotid artery dissection following chiropractic manipulation.
- The dissection led to thrombosis and a severe ischemic stroke.
Implications:
- This case suggests that individuals with undiagnosed mediolytic arteriopathy may be at increased risk of cervical artery dissection after neck manipulation.
- Further research is warranted to understand the prevalence of mediolytic arteriopathy and its association with chiropractic procedures.
- Clinicians should consider arteriopathy in the differential diagnosis of cervical artery dissection, particularly in younger patients with no traditional risk factors.
Abstract:
A 29-year-old woman died from a right hemispheric infarction caused by dissection and subsequent thrombosis of the internal carotid artery after chiropractic manipulations of the neck. Pathologic study of several arteries of muscular and elastic type revealed a mediolytic arteriopathy with widespread mucoid degeneration and cystic transformation of the vessel wall caused by segmental degeneration of smooth muscle cells of the tunica media. We hypothesize that mediolytic arteriopathy was a predisposing factor for the dissection of the internal carotid artery after chiropractic manipulations in our patient.