Abstract 1122‐000200: Chiropractor Manipulation Leading to Bilateral Vertebral Artery Dissection and Acute Ischemic Stroke
Introduction: Traumatic cervical artery dissection is one of the leading causes of stroke in patients under the age of 45. Recent chiropractic neck manipulation is associated with risk of vertebral artery dissection (VAD). The V3 segment of the vertebral artery is highly susceptible to the bending f...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-11-01
|
| Series: | Stroke: Vascular and Interventional Neurology |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.01.suppl_1.000200 |
| _version_ | 1797948351984959488 |
|---|---|
| author | Christina Xia Lee Pfaff Navreet Kaur Neil Suryadevara Hesham Masoud |
| author_facet | Christina Xia Lee Pfaff Navreet Kaur Neil Suryadevara Hesham Masoud |
| author_sort | Christina Xia |
| collection | DOAJ |
| description | Introduction: Traumatic cervical artery dissection is one of the leading causes of stroke in patients under the age of 45. Recent chiropractic neck manipulation is associated with risk of vertebral artery dissection (VAD). The V3 segment of the vertebral artery is highly susceptible to the bending forces during forced manipulation leading to intimal damage. Methods: N/A Results: This is a case presentation of a 44 year old male who was transferred from another emergency department for left homonymous inferior quadrantanopia noted on an optometrist visit. He reported sudden onset left homonymous hemianopia after receiving a high velocity cervical spine adjustment at a chiropractor appointment for chronic neck pain a few days prior. CT angiogram of the head and neck revealed bilateral vertebral artery dissection at left V2 and right V3 segments. MRI brain confirmed an acute infract in the right medial occipital lobe. His right PCA stroke was likely embolic from the injured right V3 but possibly from the left V2 as well. As the patient reported progression from a homonymous hemianopia to a quadrantanopia, he likely had a migrating embolus. Conclusions: Arterial dissection accounts for about 2% of all ischemic strokes, but may be between 8–25% in patients less than 45 years old. VAD can result from trauma of varying severities ‐ from sports, motor vehicle accidents, and chiropractor neck manipulations to violent coughing/sneezing. It is estimated that 1 in 20,000 spinal manipulation results in vertebral artery aneurysm/dissection. In the United States, patients who have multiple chronic conditions are reporting higher use of complementary or alternative medicine, including chiropractic manipulation. Education about the association of VAD and chiropractor maneuvers can be beneficial to the public as these are preventable acute ischemic strokes. In addition, vertebral artery dissection symptoms can be subtle and patients presenting to chiropractors may have distracting pain masking their deficits. Evaluating for appropriateness of cervical manipulation in high‐risk patients and detecting early clinical signs of VAD by chiropractors can be beneficial in preventing acute ischemic strokes in young patients. |
| first_indexed | 2024-04-10T21:43:04Z |
| format | Article |
| id | doaj.art-e7d0f9de84844a6591e509cf0de45e81 |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-04-10T21:43:04Z |
| publishDate | 2021-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-e7d0f9de84844a6591e509cf0de45e812023-01-18T21:39:24ZengWileyStroke: Vascular and Interventional Neurology2694-57462021-11-011S110.1161/SVIN.01.suppl_1.000200Abstract 1122‐000200: Chiropractor Manipulation Leading to Bilateral Vertebral Artery Dissection and Acute Ischemic StrokeChristina Xia0Lee Pfaff1Navreet Kaur2Neil Suryadevara3Hesham Masoud4SUNY Upstate Medical University, Syracuse New York United States of AmericaSUNY Upstate Medical University, Syracuse New York United States of AmericaSUNY Upstate Medical University, Syracuse New York United States of AmericaSUNY Upstate Medical University, Syracuse New York United States of AmericaSUNY Upstate Medical University, Syracuse New York United States of AmericaIntroduction: Traumatic cervical artery dissection is one of the leading causes of stroke in patients under the age of 45. Recent chiropractic neck manipulation is associated with risk of vertebral artery dissection (VAD). The V3 segment of the vertebral artery is highly susceptible to the bending forces during forced manipulation leading to intimal damage. Methods: N/A Results: This is a case presentation of a 44 year old male who was transferred from another emergency department for left homonymous inferior quadrantanopia noted on an optometrist visit. He reported sudden onset left homonymous hemianopia after receiving a high velocity cervical spine adjustment at a chiropractor appointment for chronic neck pain a few days prior. CT angiogram of the head and neck revealed bilateral vertebral artery dissection at left V2 and right V3 segments. MRI brain confirmed an acute infract in the right medial occipital lobe. His right PCA stroke was likely embolic from the injured right V3 but possibly from the left V2 as well. As the patient reported progression from a homonymous hemianopia to a quadrantanopia, he likely had a migrating embolus. Conclusions: Arterial dissection accounts for about 2% of all ischemic strokes, but may be between 8–25% in patients less than 45 years old. VAD can result from trauma of varying severities ‐ from sports, motor vehicle accidents, and chiropractor neck manipulations to violent coughing/sneezing. It is estimated that 1 in 20,000 spinal manipulation results in vertebral artery aneurysm/dissection. In the United States, patients who have multiple chronic conditions are reporting higher use of complementary or alternative medicine, including chiropractic manipulation. Education about the association of VAD and chiropractor maneuvers can be beneficial to the public as these are preventable acute ischemic strokes. In addition, vertebral artery dissection symptoms can be subtle and patients presenting to chiropractors may have distracting pain masking their deficits. Evaluating for appropriateness of cervical manipulation in high‐risk patients and detecting early clinical signs of VAD by chiropractors can be beneficial in preventing acute ischemic strokes in young patients.https://www.ahajournals.org/doi/10.1161/SVIN.01.suppl_1.000200VertebralIschemic Stroke |
| spellingShingle | Christina Xia Lee Pfaff Navreet Kaur Neil Suryadevara Hesham Masoud Abstract 1122‐000200: Chiropractor Manipulation Leading to Bilateral Vertebral Artery Dissection and Acute Ischemic Stroke Stroke: Vascular and Interventional Neurology Vertebral Ischemic Stroke |
| title | Abstract 1122‐000200: Chiropractor Manipulation Leading to Bilateral Vertebral Artery Dissection and Acute Ischemic Stroke |
| title_full | Abstract 1122‐000200: Chiropractor Manipulation Leading to Bilateral Vertebral Artery Dissection and Acute Ischemic Stroke |
| title_fullStr | Abstract 1122‐000200: Chiropractor Manipulation Leading to Bilateral Vertebral Artery Dissection and Acute Ischemic Stroke |
| title_full_unstemmed | Abstract 1122‐000200: Chiropractor Manipulation Leading to Bilateral Vertebral Artery Dissection and Acute Ischemic Stroke |
| title_short | Abstract 1122‐000200: Chiropractor Manipulation Leading to Bilateral Vertebral Artery Dissection and Acute Ischemic Stroke |
| title_sort | abstract 1122 000200 chiropractor manipulation leading to bilateral vertebral artery dissection and acute ischemic stroke |
| topic | Vertebral Ischemic Stroke |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.01.suppl_1.000200 |
| work_keys_str_mv | AT christinaxia abstract1122000200chiropractormanipulationleadingtobilateralvertebralarterydissectionandacuteischemicstroke AT leepfaff abstract1122000200chiropractormanipulationleadingtobilateralvertebralarterydissectionandacuteischemicstroke AT navreetkaur abstract1122000200chiropractormanipulationleadingtobilateralvertebralarterydissectionandacuteischemicstroke AT neilsuryadevara abstract1122000200chiropractormanipulationleadingtobilateralvertebralarterydissectionandacuteischemicstroke AT heshammasoud abstract1122000200chiropractormanipulationleadingtobilateralvertebralarterydissectionandacuteischemicstroke |