Cervicocephalic artery dissections due to chiropractic manipulations

Hamann, Gerhard F.; Felber, Stefan; Haaß, A.; Strittmatter, M.; Kujat, C.; Schimrigk, К.; Piepgras, U

doi:10.1016/0140-6736(93)90545-r

Cited by 24 publications

(10 citation statements)

References 9 publications

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“…All patients improved clinically after presentation, with 1 of the 4 having no residual deficits. 228 In 2006, a series of 36 VADs associated with chirotherapy of the neck were reported from 13 German academic neurology departments. At hospital discharge, 73% had a good outcome (mRS score=0-2), 1 patient died, and another remained in a vegetative state.…”

Section: Strokementioning

confidence: 99%

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

175

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3155Purpose-Cervical artery dissections (CDs) are among the most common causes of stroke in young and middle-aged adults.The aim of this scientific statement is to review the current state of evidence on the diagnosis and management of CDs and their statistical association with cervical manipulative therapy (CMT). In some forms of CMT, a high or low amplitude thrust is applied to the cervical spine by a healthcare professional. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. Results-Patients with CD may present with unilateral headaches, posterior cervical pain, or cerebral or retinal ischemia (transient ischemic or strokes) attributable mainly to artery-artery embolism, CD cranial nerve palsies, oculosympathetic palsy, or pulsatile tinnitus. Diagnosis of CD depends on a thorough history, physical examination, and targeted ancillary investigations. Although the role of trivial trauma is debatable, mechanical forces can lead to intimal injuries of the vertebral arteries and internal carotid arteries and result in CD. Disability levels vary among CD patients with many having good outcomes, but serious neurological sequelae can occur. No evidence-based guidelines are currently available to endorse best management strategies for CDs. Antiplatelet and anticoagulant treatments are both used for prevention of local thrombus and secondary embolism. Case-control and other articles have suggested an epidemiologic association between CD, particularly vertebral artery dissection, and CMT. It is unclear whether this is due to lack of recognition of preexisting CD in these patients or due to trauma caused by CMT. Ultrasonography, computed tomographic angiography, and magnetic resonance imaging with magnetic resonance angiography are useful in the diagnosis of CD. Follow-up neuroimaging is preferentially done with noninvasive modalities, but we suggest that no single test should be seen as the gold standard.

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Section: Strokementioning

confidence: 99%

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

175

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“…While some experts have called for a ban in neck manipulation (e.g. 74), I would agree with the view voiced more than a decade ago: ‘the indication for chiropractic manipulation of the cervical spine needs re‐evaluation and patients should be informed about the possibility of a dissection and give consent’ (75).…”

Section: Resultsmentioning

confidence: 91%

Vascular accidents after neck manipulation: cause or coincidence?

Ernst

2010

International Journal of Clinical Practice

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“…The incidence of dissections of the carotid and vertebral arteries in ischemic stroke is quite variable. The dissections may be spontaneous, associated with arterial dysplasia [20] or occurring after trauma [12] (fibromuscular dysplasia, chiropractic manipulations or whiplash respectively occurred in three of our cases). Possible explanations for the apparent discrepancy may be the different ages of the populations (<30 years of age for Bogousslavsky), the different timing of instrumental assessment and the different methodologies used [11,18].…”

Section: Discussionmentioning

confidence: 99%

“…The dissections may be spontaneous, associated with arterial dysplasia [20] or occurring after trauma [12] (fibromuscular dysplasia, chiropractic manipulations or whiplash respectively occurred in three of our cases). The next most frequent cause of ischemia in our series is the presence of aPLs and a number of reports suggest an association between a PLs which are immunoglobulins of the IgG, IgM, and IgA classes and stroke [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The prognosis is unpredictable.…”

Section: Discussionmentioning

confidence: 99%

Antiphospholipid antibodies and cerebral artery dissection: Two frequent causes of brain ischemia in young adults

et al. 1994

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As part of a multicenter study on ischemic stroke in the young, we report the occurrence of high antiphospholipid antibody (aPLs) levels and cerebral dissection in 75 patients. These represent the two most frequent non-thromboembolic causes of cerebral ischemia in our population. Increased aPL titres were found in nine cases (12%); cerebral artery dissection in eleven (14%). Our data stress the need to modify the classical diagnostic approach to cerebral ischemia by including hematological assessments and new neuroimaging techniques as screening tests.

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Cervicocephalic artery dissections due to chiropractic manipulations

Cited by 24 publications

References 9 publications

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Vascular accidents after neck manipulation: cause or coincidence?

Antiphospholipid antibodies and cerebral artery dissection: Two frequent causes of brain ischemia in young adults

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