Cerebellar and Spinal Injuries After Chiropractic Manipulation

Pratt-Thomas, H.R.

doi:10.1001/jama.1947.02880090022005

Cited by 153 publications

(33 citation statements)

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“…Three patients had a locked-in syn- 6 Dragon et al 7 Dunne et al 12 Frumkin and Baloh 13 Green and Joynt 14 Smith and Estridge 15 Pratt-Thomas and Berger 16 Ford and Clark drome that after 2.5-10 months was still severe. Overall, mortality or very severe long-term impairment occurs in 28% of the cases.…”

Section: Discussionmentioning

confidence: 99%

“…17 Pratt-Thomas and Berger 16 reported that their patients had, at postmortem examination, an increased range of movement at the atlantoaxial joint, as judged by the pathologist. Vertebral ligament laxity has been recently proposed as a contributing condition in stretch syncope, a clinical syndrome with complete loss of consciousness during stretching with the neck hyperextended.…”

Section: -3031mentioning

confidence: 99%

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Vertebrobasilar ischemia after neck motion.

Frisoni

Anzola

1991

Stroke

146

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Background. Vertebrobasilar ischemic strokes may occur after chiropractic manipulation of the cervical spine or, less often, after spontaneous and abrupt head movement.Summary of Review. We describe three such cases of vertebrobasilar ischemic strokes and review 36 other reported cases.Conclusions. We give evidence that 1) the population at risk cannot be identified a priori in the vast majority of cases; 2) symptoms may develop after many uneventful manipulations; 3) clinical syndromes consist of occipital lobe (5%), cerebellar (8%), locked-in (8%), Wallenberg's (28%), other brain stem (49%), and unclassifiable (2%); 4) mortality or very severe long-term impairment occurs in 28% of cases; 5) the development of transient neurological symptoms during previous manipulations, the presence of known or suspected ligament laxity, and, if known, the presence of a vertebral artery terminating in posterior inferior cerebellar artery should always contraindicate any chiropractic neck maneuver, and 6) the pathogenetic mechanism involves vertebral artery dissection at the atlantoaxial joint with intimal tear, intramural bleeding, or pseudoaneurysm that can lead to thrombosis or embolism. (Stroke 1991;22:1452-1460)

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Section: Discussionmentioning

confidence: 99%

Section: -3031mentioning

confidence: 99%

Vertebrobasilar ischemia after neck motion.

Frisoni

Anzola

1991

Stroke

146

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“…This artery is particularly susceptible to injury or occlusion following cervical fracture dislocation, 2 cervical traction, 3 hyperextension, 6 and hyperrotation. 4 ' 10 Three main sites of compression associated with fracture dislocation have been described at the level of the fifth and sixth cervical vertebrae, atlanto-axial joint, and atlanto-occipital joint.…”

Section: Discussionmentioning

confidence: 99%

“…6 This article presents a description of a lateral medullary syndrome following sustained physiological hyperextension, rotation, and lateral flexion movements of the head for a period of several hours. The angiographical survey demonstrated complete obstruction of the right vertebral artery associated with severe stenosis of the vertebral artery on the left.…”

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Vertebral Artery Occlusion Following Hyperextension and Rotation of the Head

Okawara

Nibbelink

1974

Stroke

117

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Abstract:Vertebral Artery Occlusion Following Hyperextension and Rotation of the Head• This is a case report of a lateral medullary syndrome of Wallenberg following occlusion of one vertebral artery and stenosis of the opposite artery precipitated by combined motion of hyperextension, rotation, and lateral flexion of the head within physiological limits. Sufficient duration of such head position appeared to initiate thrombus formation following stenosis or occlusion of the vertebral artery at the level of the atlanto-occipital joint. Propagation of this thrombus obstructed the posterior inferior cerebellar artery causing infarction of the lateral medullary region. The pathogenesis of this mechanism is discussed. Additional Key WordsWallenberg syndrome vertebral artery thrombosis posterior inferior cerebellar artery atlanto-occipital joint However, the mechanism of arterial occlusion, thrombosis, and infarction has not been clarified from postmortem or clinical findings. 6This article presents a description of a lateral medullary syndrome following sustained physiological hyperextension, rotation, and lateral flexion movements of the head for a period of several hours. The angiographical survey demonstrated complete obstruction of the right vertebral artery associated with severe stenosis of the vertebral artery on the left. The clinical course and angiographical abnormalities provide an interesting sequence of events which suggest a probable mechanism of progression for this type of vascular occlusion. Case ReportA 43-year-old left-handed male draft designer experienced occasional nonvertiginous dizziness for two years. On March 21, 1974, he painted the ceilings of two rooms in his home, beginning in the early morning and finishing in the late afternoon. While painting, he used a roller or brush in his left hand. Therefore, his head was maintained in hyperextension, rotated to the left, and tilted to the right. Occasionally he used his right hand while his head remained hyperextended, rotated to the right, and tilted to the left. During that afternoon, he noted occasional dizziness as he used his right hand. The remainder of the day was not unusual and he was in no particular distress. The next morning, From the Division of Neurosurgery, Department of Neurology, University of Iowa College of Medicine, Iowa City, Iowa 52242. however, on March 22, 1974, he experienced an abrupt onset of severe headache, unsteadiness, numbness of the right side of his face, difficulty swallowing, and loss of taste on the right side of the tongue. As he attempted to climb into bed, he fell to the floor with marked loss of balance, but noted no change in level of consciousness. On March 23rd he was admitted to a local hospital where his ataxia and headache increased gradually. On admission to University of Iowa Hospitals on March 28th, examination revealed an alert and well-oriented man with a blood pressure of 140/80 mm Hg. The cranial nerve examination revealed absence of corneal reflex, and marked impairment of sensation to touch ...

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“…8 ' 7 Chiropractic manipulations of the neck may also produce brain infarction. 8 " 19 Miller and Burton" emphasized that patients with cervical spondylosis or vertebro-basilar insufficiency should not undergo chiropractic manipulation and that it should be terminated immediately in any patient who develops ischemic symptoms.…”

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confidence: 99%