A 48-year-old woman with chronic neck pain presented with a history of sudden neck pain and generalized weakness during a chiropractic session. Neurologic examination showed tetraplegia with C5 sensory level. Cervical spine CT revealed a fracture affecting C5 and C6 vertebra (Figure , A and B). Cervical spine MRI confirmed spinal cord injury (Figure , C). Bilateral vertebral artery occlusion and acute cerebellar infarction were found (Figure , D-F). Bony ankylosis was found in cervical CT spine, suggesting undiagnosed ankylosing spondylitis was a risk factor for spine fracture. Other neurologic lesions related to chiropractic manipulation include vertebral artery dissection, epidural hematoma, and acute disk herniation. 1,2 Study FundingThe authors report no targeted funding. Figure Spinal Cord Injury, Vertebral Artery Dissection, and Cerebellar Strokes after Chiropractic Manipulation (A, B) Sagittal cervical spine CT revealed a fracture and intense bony ankylosis. (C) T2-weighted sagittal cervical spinal cord MRI showed a spinal cord injury. (D) CT angiography identified bilateral vertebral artery occlusion. (E, F) Axial diffusion-weighted imaging and fluid-attenuated inversion recovery brain MRI documented cerebellar ischemia.
Resumo: O projeto "Educação Sexual e Reprodutiva" é uma iniciativa de extensão universitária criada por estudantes de medicina que busca abordar, de forma interativa e inovadora, temas de grande relevância para adolescentes, geralmente negligenciados nas escolas brasileiras, como HIV/AIDS, aborto, gênero e orientação sexual. Três oficinas e uma gincana final foram realizadas junto a estudantes de uma escola pública de ensino médio. Para conduzi-las, alunos de graduação médica voluntários foram treinados por seus colegas, coordenadores da iniciativa, sendo previamente apresentados ao conteúdo teórico e preparados para uma abordagem horizontal e participativa junto aos escolares, ao modo da educação por pares. Para avaliação do impacto da intervenção, foram feitas análises qualitativa, com diários de campo, e quantitativa, com aplicação de questionários. Esses instrumentos evidenciaram um significativo aprendizado dos escolares sobre os assuntos trabalhados. Realizou-se também análise de impacto sobre os estudantes de medicina envolvidos no projeto, que demonstrou aumento do conhecimento teórico, ganho de confiança e fortalecimento da capacidade de argumentar contra atitudes preconceituosas. Os resultados do estudo afirmam o interesse do tema e da estratégia como prática extensionista, além de apontar aspectos que reclamam atenção e aprimoramento. Palavras-chave: Jovens, Sexualidade, EnsinoContent shared under Creative Commons Attribution 4.0 Licence CC-BY Abstract: The "Sexual and Reproductive Education" project is an academic community service initiative created by medical students aiming to address, in an interactive and innovative way, topics of great importance for adolescents but generally neglected or poorly worked in Brazilian schools, such as HIV/AIDS, abortion, gender and sexual orientation. Workshops and a final playful competition were held at a public high school. To carry them out, volunteer medical students were trained by colleagues, being introduced to the theoretical base and prepared for a horizontal and participatory approach, in the sense of a peer education strategy. A qualitative analysis was performed to evaluate the intervention's impact, with field diaries, and a quantitative one, with the application of questionnaires. These evaluation tools showed significant knowledge gain. We also carried out an analysis of the impact of the project on the undergraduate medical students involved in the initiative, which revealed an increase in the theoretical knowledge, gain in confidence and strengthening of the ability to argue against prejudiced attitudes. The study results stress the interest of the subject and strategy as an academic community service initiative but also highlight aspects that need attention and improvement.Educación sexual y reproductiva para adolescentes como educación entre pares: evaluación de una experiencia de extensión universitaria Resumen: El proyecto "Educación Sexual y Reproductiva" es una iniciativa de extensión universitaria por parte de estudiantes de medicina que bu...
Context: Chiropractic is a form of spinal manipulation used to treat cervical pain. This therapy is considered safer than chronic use of anti-inflammatory drugs, opioids or spine surgery. However, chiropractic may cause severe complications such as myelopathy and ischemic stroke. Case report: A 48-year-old woman was admitted to our hospital due to acute tetraparesis. During a chiropractic session for chronic neck pain, patient referred lancinating cervical pain, weakness in the upper and lower limbs, and numbness below the level of the neck. Neurologic examination showed grade two tetraparesis with preserved arm abduction. Pain and vibratory sensation were reduced in trunk, upper and lower limbs. We considered a C5 level spinal cord injury. Cervical spine magnetic resonance imaging revealed a transdiscal fracture of C5-C6 vertebrae. The fracture led to an epidural hematoma and spinal cord compression. Cervical spine displayed ligamenta flava thickening, which may be associated with an undiagnosed ankylosing spondylitis. We also found bilateral vertebral occlusion of V1 and V2 segments. Cerebellar restricted diffusion suggested posterior circulation stroke. We believe that rigidity associated with ankylosing spondylitis favored spinal fracture during chiropractic. Patient was treated with 24mg/day of dexamethasone and 100mg/day of aspirin. Spinal cord decompression surgery was indicated. Unfortunately, in the last followup there was no improvement in patient motor status. Conclusions: Transdiscal C5-C6 fracture led to compressive myelopathy and cerebellar stroke. Safety of chiropractic should be better investigated in specific populations such as ankylosing spondylitis patients.
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