Journal of Manipulative and Physiological Therapeutics
Case reportStroke after chiropractic manipulation as a result of extracranial postero-inferior cerebellar artery dissection*
Introduction
Vertebro-basilarstroke after cervical spine manipulation is well known and is generally the result of vertebral artery dissection at the C1-C2 level.
The postero-inferior cerebellar artery (PICA) is a cerebellar artery that generally originates from the vertebral artery at the intradural level and is not usually injured after a cervical trauma. However, this artery may sometimes originate from the vertebral artery below the level of the foramen magnum. In this case, the first few centimeters are situated at the cervical level and have close anatomic links with the first cervical vertebrae. Consequently, the PICA can be injured directly after cervical trauma if its origin is extracranial. We describe a case of PICA dissection after cervical manipulation.
Section snippets
Case report
A 42-yr-old woman had chronic neckaches that responded poorly to anti-inflammatory and antalgic treatments. Clinical examination by a chiropractor revealed stiffness of the neck with muscular contraction. In addition to spontaneous pains in the neck, the manipulation during the clinical exam provoked a radiation of the pain toward her arm and the external forearm on the right side. Neurologic examination was normal. A magnetic resonance imaging (MRI) scan of the cervical spine carried out 1
Discussion
Manipulation of the cervical spine is used in the treatment of neck pain and muscle-tension headache. Such therapy may expose patients to vertebrobasilar ischemia and lesions of the brain stem. Such serious accidents with serious consequences and sometimes permanent invalidity have been estimated at about 200 in the literature1, 2; they are usually secondary to dissection of the vertebral artery.3, 4, 5, 6, 7, 8, 9, 10, 11, 12
Specific clinical syndromes, such as the locked-in and Wallenberg
Conclusion
Dissection of cervical arteries does not only include the vertebral and carotid arteries. Dissection of the PICA, after neck manipulation, is possible if its origin is extracranial. We emphasise that these anatomic variations may constitute a predisposing factor for stroke after spinal manipulative therapy of the neck.
References (16)
- et al.
Complications of spinal manipulation. A comprehensive review of the literature
J Fam Pract
(1996) - et al.
Manipulation and mobilization of the cervical spine
Spine
(1996) - et al.
Vertebrobasilar ischemia after neck motion
Stroke
(1991) - et al.
Stroke following chiropractic manipulation of the cervical spine
J Neurol
(1999) - et al.
Vertebral and carotid artery dissection following chiropractic cervical manipulations
Neurosurg Rev
(1999) - et al.
Manipulations of cervical vertebrae and trauma of the vertebral artery. Report of two cases
J Mal Vasc
(1996) - et al.
Vertebral artery dissection diagnosed with CT
AJNR Am J Neuroradiol
(1995) - et al.
Wallenberg's syndrome due to vertebral artery dissection following minimal neck injury—report of two cases
Rinsho Shinkeigaku
(1992)
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