Maternal protein malnutrition during the last third of pregnancy malprograms the metabolism of rat offspring, resulting in increased vulnerability to HFD-induced obesity, and the correlated metabolic impairment might be associated with lower sympathetic nerve activity in adulthood.

A 48-year-old woman with chronic neck pain presented with a history of sudden neck pain and generalized weakness during a chiropractic session. Neurologic examination showed tetraplegia with C5 sensory level. Cervical spine CT revealed a fracture affecting C5 and C6 vertebra (Figure , A and B). Cervical spine MRI confirmed spinal cord injury (Figure , C). Bilateral vertebral artery occlusion and acute cerebellar infarction were found (Figure , D-F). Bony ankylosis was found in cervical CT spine, suggesting undiagnosed ankylosing spondylitis was a risk factor for spine fracture. Other neurologic lesions related to chiropractic manipulation include vertebral artery dissection, epidural hematoma, and acute disk herniation. 1,2 Study FundingThe authors report no targeted funding. Figure Spinal Cord Injury, Vertebral Artery Dissection, and Cerebellar Strokes after Chiropractic Manipulation (A, B) Sagittal cervical spine CT revealed a fracture and intense bony ankylosis. (C) T2-weighted sagittal cervical spinal cord MRI showed a spinal cord injury. (D) CT angiography identified bilateral vertebral artery occlusion. (E, F) Axial diffusion-weighted imaging and fluid-attenuated inversion recovery brain MRI documented cerebellar ischemia.

Context: Chiropractic is a form of spinal manipulation used to treat cervical pain. This therapy is considered safer than chronic use of anti-inflammatory drugs, opioids or spine surgery. However, chiropractic may cause severe complications such as myelopathy and ischemic stroke. Case report: A 48-year-old woman was admitted to our hospital due to acute tetraparesis. During a chiropractic session for chronic neck pain, patient referred lancinating cervical pain, weakness in the upper and lower limbs, and numbness below the level of the neck. Neurologic examination showed grade two tetraparesis with preserved arm abduction. Pain and vibratory sensation were reduced in trunk, upper and lower limbs. We considered a C5 level spinal cord injury. Cervical spine magnetic resonance imaging revealed a transdiscal fracture of C5-C6 vertebrae. The fracture led to an epidural hematoma and spinal cord compression. Cervical spine displayed ligamenta flava thickening, which may be associated with an undiagnosed ankylosing spondylitis. We also found bilateral vertebral occlusion of V1 and V2 segments. Cerebellar restricted diffusion suggested posterior circulation stroke. We believe that rigidity associated with ankylosing spondylitis favored spinal fracture during chiropractic. Patient was treated with 24mg/day of dexamethasone and 100mg/day of aspirin. Spinal cord decompression surgery was indicated. Unfortunately, in the last followup there was no improvement in patient motor status. Conclusions: Transdiscal C5-C6 fracture led to compressive myelopathy and cerebellar stroke. Safety of chiropractic should be better investigated in specific populations such as ankylosing spondylitis patients.