Vertebrobasilar ischemia after neck motion.

Abstract

Background. Vertebrobasilar ischemic strokes may occur after chiropractic manipulation of the cervical spine or, less often, after spontaneous and abrupt head movement.Summary of Review. We describe three such cases of vertebrobasilar ischemic strokes and review 36 other reported cases.Conclusions. We give evidence that 1) the population at risk cannot be identified a priori in the vast majority of cases; 2) symptoms may develop after many uneventful manipulations; 3) clinical syndromes consist of occipital lobe (5%), cerebellar (8%), locked-in (8%), Wallenberg's (28%), other brain stem (49%), and unclassifiable (2%); 4) mortality or very severe long-term impairment occurs in 28% of cases; 5) the development of transient neurological symptoms during previous manipulations, the presence of known or suspected ligament laxity, and, if known, the presence of a vertebral artery terminating in posterior inferior cerebellar artery should always contraindicate any chiropractic neck maneuver, and 6) the pathogenetic mechanism involves vertebral artery dissection at the atlantoaxial joint with intimal tear, intramural bleeding, or pseudoaneurysm that can lead to thrombosis or embolism. (Stroke 1991;22:1452-1460)

Bow Hunter's Stroke Caused by a Severe Facet Hypertrophy of C1-2

“…In most reported cases, patients with ischemic attacks induced by rotational occlusion of one VA had an opposite VA that was hypoplastic, stenotic, or occluded. The VAs at the atlantoaxial level are particularly prone to mechanical compression during head and neck rotation because of its unique relationship to the surrounding transverse foramina, paravertebral muscles, and fibrous ligaments 1,5,6) . Axial rotation at the C1-2 level may cause VA occlusion within normal range of motion due to the relatively fixed position of the artery within the posterior arch of the atlas 5,14) .…”

“…This rare and unique symptomatic vertebrobasilar insufficiency or infaction is named "bow hunter's stroke" after the first description by Sorensen 15) . Various pathologic conditions have been reported as causes of bow hunter's stroke 3,[5][6][7]11,14) . We report a 71-year-old woman with rotatory occlusion of VA from rare massive facet hypertrophy at the C1-2 level treated by C1-2 posterior fixation and fusion.…”

Consequences of neck manipulation performed by a non-professional

“…Mortality or severe de®cits have been reported in 28% patients. 1 A neuro®broma may lie silent for long and may be discovered accidentally. 5 Our patient did not have symptoms due to the tumor before the neck manipulation.…”

“…1,2 Rarely underlying silent tumors may be uncovered by neurological de®cits following neck manipulation eg tetraplegia and death resulted in an infant with spinal cord astrocytoma who underwent chiropractic manipulation for torticollis. 3 In India, neck manipulation is commonly practiced by barbers who perform it after a hair cut and massage.…”

The effect of end-range cervical rotation on vertebral and internal carotid arterial blood flow and cerebral inflow: A sub analysis of an MRI study

“…A velocity encoding value of 100 cm/s was used. The selected imaging plane was at the level of the C1 vertebra and atlas loop of the VA, this being the site of most reported manipulative injuries of the VA (Frisoni and Anzola 1991, Hurwitz, Aker et al 1996, Haldeman, Kohlbeck et al 1999). …”