Near-fatal stroke prompts warning about chiropractic neck manipulation  


By Michael Woodhead

9 Aug 2021

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.

The patient made some improvement in internal carotid artery dissection with increased cerebral perfusion after three months. After one year of rehabilitation he had shown slight improvement in motor function  and was is able to manage his activities of daily living without assistance. However he still had significant dysphasia and was unable to return to his previous employment.

They said that while most cases of internal carotid artery dissection are spontaneous, about 4% are caused by trauma and these tend to be in younger people. In rare cases it may occur following minor trauma or physical exertion, as appeared to be the cause in this unusual case.

“We propose that massage and neck manipulation is an independent risk factor for developing internal carotid artery dissection in healthy individuals,” they wrote.

“Cervical spine manipulation in the form of neck massage is a rare but ‘not to miss’ trigger/cause of internal carotid artery dissection, which potentially translates into clinically significant morbidity and mortality,” they concluded.

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