This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Frisoni, G. B. Articles by Anzola, G. P. Search for Related Content PubMed PubMed Citation Articles by Frisoni, G. B. Articles by Anzola, G. P.

Stroke, Vol 22, 1452-1460, Copyright © 1991 by American Heart Association

ARTICLES

Vertebrobasilar ischemia after neck motion

GB Frisoni and GP Anzola
Clinica Neurologica dell'Universita di Brescia, Spedali Civili, Italy.

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.

This article has been cited by other articles:

				M. D. Christian and A. S. Detsky A Twist of Fate? N. Engl. J. Med., July 1, 2004; 351(1): 69 - 73. [Full Text] [PDF]

				M. Sakaguchi, K. Kitagawa, H. Hougaku, H. Hashimoto, Y. Nagai, H. Yamagami, T. Ohtsuki, N. Oku, K. Hashikawa, K. Matsushita, et al. Mechanical compression of the extracranial vertebral artery during neck rotation Neurology, September 23, 2003; 61(6): 845 - 847. [Abstract] [Full Text] [PDF]

				R. P Di Fabio Manipulation of the Cervical Spine: Risks and Benefits Physical Therapy, January 1, 1999; 79(1): 50 - 65. [Abstract] [Full Text] [PDF]

				R. D. Sheth, M. Jaynes, M. Gingold, O. Ortiz, and J. B. Bodensteiner Stroke Due to a Traumatic Vertebral Artery Dissection in a Girl Clinical Pediatrics, August 1, 1994; 33(8): 503 - 506. [PDF]