Recurrent Stroke in a Child With Atlantoaxial Instability Following Chiropractic Manipulation

Ghanim, Majd T.; Bergmann, Shayla; Turner, Raymond D; Eskandari, Ramin; Mahajerin, Arash

doi:10.1097/mph.0000000000001559

Cited by 8 publications

(6 citation statements)

References 11 publications

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“…Therefore, if vertebral artery dissection accompanies dynamic occlusion, prevention of secondary stroke begins with antithombotic treatment and immobilization until evidence of dissection resolution. 4,9,11,13 However, the cases in Table 1 with recurrent stroke started with aspirin therapy, then therapy was escalated when recurrent stroke occurred on aspirin, suggesting that in many cases, medical therapy alone is not enough. Specific pathology should then be used as a guide for further intervention.…”

Section: Discussionmentioning

confidence: 99%

“…For the other patient, on long-term follow-up both stents were found to be sheared with complete occlusion of both vertebral arteries and muscular branch collateralization reconstituting V3. 11 Therefore, vertebral artery stenting is also not recommended for long-term prevention of stroke from atlantoaxial rotation causing vertebral artery occlusion, either unilateral or bilateral.…”

Section: Discussionmentioning

confidence: 99%

“…Almost a quarter (23%, 6/26) had reports of head/neck trauma or intensive sports participation before symptom onset; 1 patient also received chiropractic neck manipulation after a fall. 11 One patient received a genetic workup for connective tissue disorder, 13 although several did have normal echocardiography, suggesting those patients did not have cardiac signs of connective tissue disorder. Our reported patient has not yet received genetic evaluation for connective tissue disorder because her follow-up stroke clinic visit was canceled because of the COVID-19 pandemic.…”

Section: Methodsmentioning

confidence: 99%

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Bow Hunter’s Syndrome in Children: A Review of the Literature and Presentation of a New Case in a 12-Year-Old Girl

2020

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Background: Bow hunter's syndrome, or occlusion of the vertebral artery with head rotation leading to ischemia and sometimes stroke, is rarely described in children. The authors review the literature and present a new case. Methods: Both OVID dating back to 1946 and PubMed records were reviewed using the terms (“Bow hunter syndrome” OR “bow hunter’s”) OR “rotational vertebral artery occlusion” combined with “child,” and limited to English language. SCOPUS and the bibliographies of cases found in the search were used to identify additional articles. Results: Twelve articles were found describing 25 patients; there were 26 patients when combined with our case. Ages ranged from 1 to 18 years. Most (88.5%, 23/26) were male. Medical treatments included aspirin, clopidogrel, abciximab, enoxaparin, warfarin, and cervical collar. Stenting was tried in 2 cases but did not work long-term. Surgical treatments included decompression, cervical fusion, or a combination. We present a new case of a 12-year-old girl with recurrent stroke who had bilateral vascular compression only visible on provocative angiographic imaging with head turn. She was referred for cervical fusion, and abnormal ligamentous laxity was noted intraoperatively. Conclusions: Bow hunter's syndrome is a rare but important cause of stroke since many of the patients experience recurrent strokes before the diagnosis is made. Reasons for the male predominance are unclear. Provocative angiography plays a key role in diagnosis, and both medical treatment and neurosurgical intervention may prevent recurrence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Bow Hunter’s Syndrome in Children: A Review of the Literature and Presentation of a New Case in a 12-Year-Old Girl

2020

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“…The great majority of these ( n = 166) were reports of serious adverse events in case-reports, case-series or retrospective case reviews (including several reviews of cases captured in medico-legal records [ 19 – 23 ]) [ 19 – 184 ]. These were regularly published as ‘case-reports’ in the form of letters in medical journals ( n = 19) [ 185 – 203 ] or as abstracts of cases presented at conferences ( n = 17) [ 25 , 26 , 29 , 31 , 32 , 42 , 46 , 59 , 66 , 68 , 77 , 92 , 107 , 112 , 115 , 145 , 148 ].…”

Section: Review Findingsmentioning

confidence: 99%

What are the risks of manual treatment of the spine? A scoping review for clinicians

Swait¹,

Finch²

2017

Chiropr Man Therap

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BackgroundCommunicating to patients the risks of manual treatment to the spine is an important, but challenging element of informed consent. This scoping review aimed to characterise and summarise the available literature on risks and to describe implications for clinical practice and research.MethodA methodological framework for scoping reviews was followed. Systematic searches were conducted during June 2017. The quantity, nature and sources of literature were described. Findings of included studies were narratively summarised, highlighting key clinical points.ResultsTwo hundred and fifty articles were included. Cases of serious adverse events were reported. Observational studies, randomised studies and systematic reviews were also identified, reporting both benign and serious adverse events.Benign adverse events were reported to occur commonly in adults and children. Predictive factors for risk are unclear, but for neck pain patients might include higher levels of neck disability or cervical manipulation. In neck pain patients benign adverse events may result in poorer short term, but not long term outcomes.Serious adverse event incidence estimates ranged from 1 per 2 million manipulations to 13 per 10,000 patients. Cases are reported in adults and children, including spinal or neurological problems as well as cervical arterial strokes. Case-control studies indicate some association, in the under 45 years age group, between manual interventions and cervical arterial stroke, however it is unclear whether this is causal. Elderly patients have no greater risk of traumatic injury compared with visiting a medical practitioner for neuro-musculoskeletal problems, however some underlying conditions may increase risk.ConclusionExisting literature indicates that benign adverse events following manual treatments to the spine are common, while serious adverse events are rare. The incidence and causal relationships with serious adverse events are challenging to establish, with gaps in the literature and inherent methodological limitations of studies. Clinicians should ensure that patients are informed of risks during the consent process. Since serious adverse events could result from pre-existing pathologies, assessment for signs or symptoms of these is important. Clinicians may also contribute to furthering understanding by utilising patient safety incident reporting and learning systems where adverse events have occurred.Electronic supplementary materialThe online version of this article (10.1186/s12998-017-0168-5) contains supplementary material, which is available to authorized users.

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“…We critically appraised 33 studies. Of those, eight had a low or unacceptable quality and were excluded from the evidence synthesis [38][39][40][41][42][43][44][45]. These included seven case reports or case series, and one cohort study.…”

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

The safety of spinal manipulative therapy in children under 10 years: a rapid review

et al. 2020

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Introduction: The safety of spinal manipulative therapy (SMT) in children is controversial. We were mandated by the College of Chiropractors of British Columbia to review the evidence on this issue. Objectives: We conducted a rapid review of the safety of SMT in children (< 10 years). We aimed to: 1) describe adverse events; 2) report the incidence of adverse events; and 3) determine whether SMT increases the risk of adverse events compared to other interventions. Evidence review: We searched MEDLINE, CINAHL, and Index to Chiropractic Literature from January 1, 1990 to August 1, 2019. We used rapid review methodology recommended by the World Health Organization. Eligible studies (case reports/series, cohort studies and randomized controlled trials) were critically appraised. Studies of high and acceptable methodological quality were included. The lead author extracted data. Data extraction was independently validated by a second reviewer. We conducted a qualitative synthesis of the evidence. Findings: Most adverse events are mild (e.g., increased crying, soreness). One case report describes a severe adverse event (rib fracture in a 21-day-old) and another an indirect harm in a 4-month-old. The incidence of mild adverse events ranges from 0.3% (95% CI: 0.06, 1.82) to 22.22% (95% CI: 6.32, 54.74). Whether SMT increases the risk of adverse events in children is unknown. Conclusion: The risk of moderate and severe adverse events is unknown in children treated with SMT. It is unclear whether SMT increases the risk of adverse events in children < 10 years.

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Recurrent Stroke in a Child With Atlantoaxial Instability Following Chiropractic Manipulation

Cited by 8 publications

References 11 publications

Bow Hunter’s Syndrome in Children: A Review of the Literature and Presentation of a New Case in a 12-Year-Old Girl

Bow Hunter’s Syndrome in Children: A Review of the Literature and Presentation of a New Case in a 12-Year-Old Girl

What are the risks of manual treatment of the spine? A scoping review for clinicians

The safety of spinal manipulative therapy in children under 10 years: a rapid review

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