Doctors in WA have warned of the rare but serious risk of stroke triggered by chiropractor massage citing the example of a near-fatal massive stroke in an otherwise healthy young man.
Writing in BMJ Case Reports, Dr Tim Yap and Dr Daniel Xu of Curtin University, Perth, Western Australia, describe the case of a 35-year-old Chinese man who presented with a two-day history of expressive dysphasia and a one-day history of right-sided weakness. He had recently undergone multiple sessions of chiropractic neck manipulation and massage for pain relief.
In their report they say the man had no risk factors for stroke, but CT of his brain showed a middle cerebral artery infarct and left internal carotid artery dissection.
Infarction due to left carotid arterial dissection was confirmed with MRI and a cerebral perfusion scan was consistent with a severe MCA infarction. The patient also had intimal oedema of bilateral vertebral arteries.
In the absence of other cardiac, vascular and thrombotic conditions they concluded that the near-fatal cerebrovascular event factors was precipitated by massage-induced internal carotid arterial dissection.
The man was managed conservatively with supportive treatment as he presented too late for thrombolysis and thrombectomy, and anticoagulation was contraindicated due to large areas of infarct which may increase his risk of haemorrhagic conversion.