Vertebral artery dissection in evolution found during chiropractic examination

Abstract

A 30-year-old woman presented to an emergency department with sudden onset of transient loss of left peripheral vision. Owing to a history of migraine headaches, she was released with a diagnosis of ocular migraine. Two days later, she sought chiropractic care for the chief symptom of severe neck pain. The chiropractor suspected the possibility of vertebral artery dissection (VAD). No manipulation was performed; instead, MR angiography (MRA) of the neck was obtained, which revealed an acute left VAD with early thrombus formation. The patient was placed on aspirin therapy. Repeat MRA of the neck 3 months later revealed resolution of the thrombus, without progression to stroke. This case illustrates the importance for all healthcare providers who see patients with neck pain and headache to be attentive to the symptomatic presentation of possible VAD in progress.

The potential dangers of neck manipulation & risk for dissection and devastating stroke: An illustrative case & review of the literature

“…Futch et al, 2015 urge chiropractic colleagues to have a high suspicion of vertebral artery dissection when patients come in for treatment with sudden neck pain and headache [ 39 ]. The use of magnetic resonance angiography in these cases may prevent the chiropractor from performing potentially dangerous manipulations in at risk individuals.…”

Chiropractic case reports: a review and bibliometric analysis

“…Case management CRs in the fourth-fastest growing category, Diseases of the circulatory system (I00-I99), began with the first publication in 1986 [ 68 ], with the yearly volume peaking in 2014. Examples include CRs in which chiropractors suspected and referred patients with vertebral artery dissection [ 69 – 71 ], ischemic stroke [ 72 ], hemorrhagic stroke [ 73 ], upper [ 74 , 75 ] and lower [ 76 , 77 ] extremity deep vein thrombosis, abdominal aortic aneurysm [ 68 , 78 – 81 ], intracranial aneurysm [ 82 ], popliteal aneurysm [ 83 ], myocardial infarction [ 84 ] and subdural hematoma [ 85 ].…”

Attitudes Towards Chiropractic: A Repeated Cross-Sectional Survey of Canadian Family Physicians 

“…This suggests that associations reported in some studies between chiropractic care and stroke may be due to patients with early dissection-related symptoms seeking care prior to developing their strokes. [52][53][54] Musculoskeletal complaints, particularly low back pain, are common complaints in primary care. 55 Our ndings suggest that most Canadian family physicians believe chiropractors can provide effective care for some musculoskeletal complaints; however, many physicians do not believe that chiropractors treat in accordance with evidence-based practices and have concerns regarding the safety of cervical manipulation.…”