In 2015 I wrote a blog post titled: Stroke
From A Chiropractic Adjustment?The Evidence Says No. In that post it was revealed that the
referenced studies showed patient’s suffering a Vertebral Artery Dissection
(VAD) did not receive a chiropractic neck adjustment in 1/3 of the cases.
Furthermore, of all of the patients studied from that visited their primary
care physician (PCP) none of the PCP’s patients were given a chiropractic
adjustment or other type of neck manipulation of any form. So this begs the
question, how are patient’s suffering a VAD type stroke when 1/3 of the
chiropractic patients were never adjusted yet still suffered a VAD? How did
patients visiting their primary care medical physician suffer a VAD type stroke
when none of their patients received any type of neck manipulation?
The conclusions were obvious. The
patient was walking into their chiropractic physician (DC) and their PCP’s office
for treatment of symptoms that were associated with the VAD in progress.
This is further illustrated by a case
report from the British Medical Journal: BMJ Case Rep. 2015; 2015:
bcr2015212568. Vertebral artery dissection in evolution found during
chiropractic examination. In this published case study the authors report the
following case history:
“A 30-year-old otherwise healthy woman consulted a chiropractor, reporting right-sided neck pain in the suboccipital region. The patient reported that, 3 days previously, she had gone to the local hospital emergency department (ED) because of the sudden onset of loss of left peripheral vision. The visual symptoms interfered with her ability to see through her left eye; this was accompanied by ‘numbness’ in her left eyelid. About 2 weeks prior to this ED visit, she had experienced an episode of acute left-sided neck pain with severe left-sided headache. She also related a history of migraine headache without prodrome. She was released from the ED with a tentative diagnosis of ocular migraine. She had never been previously diagnosed with ocular migraine, nor had she ever experienced any visual disturbances with her previous migraines.
Shortly after the left-sided ocular symptoms resolved, she suddenly developed right-sided neck pain without provocation, for which she sought chiropractic treatment. She also reported a transient episode of right-sided visual disturbance occurring that same day as well. This was described as sudden blurriness that was of short duration and resolved spontaneously earlier in the day of her presentation for chiropractic examination. When she presented for the initial chiropractic examination, she denied current visual disturbance. She said that she was not experiencing any numbness, paresthesia or motor loss in the upper or lower extremities. She denied ataxia or difficulty with balance. Medical history was remarkable for childbirth 2½ months prior to initial presentation. She stated that her migraine headaches were associated with her menstrual cycle. Family history was remarkable for a spontaneous ascending thoracic aortic aneurysm in her older sister, who was about 30 years of age when her aneurysm had occurred.”
The hospital’s emergency
department released the patient with a tentative diagnosis of ocular migraine,
due to her history of migraine headaches. However, the patient stated that the left-sided headache was atypical—“like
nothing I've ever experienced before.” Her previous migraines were
associated with her menstrual cycle, but not with any vision changes. She had
never been previously diagnosed with ocular migraine.
Based on the history of sudden onset of severe upper cervical spine
pain and headache with visual disturbance and ocular numbness, the chiropractic
physician was concerned about the possibility VAD. Magnetic resonance
angiography (MRA) and MRI of the neck and head were performed because the neck
pain and headaches were related to vertebral artery dissection rather than to a
mechanical disorder. Due to this suspicion, the chiropractic physician did not
perform a physical exam or neck manipulation/adjustment.
The MRA of the cervical region revealed that the
patient actually had an acute dissection with thrombus formation in the left
vertebral artery. The
symptoms she had been experiencing, including the headache, neck pain and
visual disturbances were symptoms of the VAD in process.
The patient was admitted to the hospital for close neurological
monitoring. During her hospital stay symptoms of headache and neurological
deficits improved. She was discharged the following day with a diagnosis of
left vertebral artery dissection and transient ischemic attack. She was
instructed to avoid vigorous exercise and trauma to her neck. Daily aspirin was
prescribed or 3-6 months. MRI/MRA imaging was repeated 3 months later which demonstrated improved diameter of the
cervical left vertebral artery with resolution of the thrombus within the false
lumen. The imaging of the intracranial compartment remained normal, without
evidence of interval infarction or perfusion asymmetry.
This case report
demonstrates what my previous post illustrated. While there is an association between
chiropractic and VAD, there is no causation. The case above clearly
demonstrates that patients are presenting with neck pain and headaches that are
associated with a VAD in progress. In a
typical scenario, the patient would have been discharged from the emergency
department, gone to the chiropractor and the chiropractor would have been
accused of causing the patient’s VAD.
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Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine. www.NaturalSportsMedicine.com
