VA dissection from chiro manipulation

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Tapspatellas

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20 something year old in our area just had a VA dissection from a chiropractic manipulation last week. Was talking with our neurosurgeons about it at lunch. Cerebellar CVA and a mess.

Just wanted to remind everyone that this happens.

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20 something year old in our area just had a VA dissection from a chiropractic manipulation last week. Was talking with our neurosurgeons about it at lunch. Cerebellar CVA and a mess.

Just wanted to remind everyone that this happens.
Seen it twice
Both young guys. One died.
I always educate cervical patients on this if they check chiro care on the intake box
 
This is the reason it's best to avoid chiro treatments for the next. Better to stick with less aggressive, traditional PT, for the neck where appropriate or necessary at all.

I've seen a couple of these in my ED days, neither related to chiro treatments. One was a young guy with the no neuro symptoms but "worst headache" of his life at base of head and neck, picked up incidentally on non-contrast head CT (which doesn't always even pick it up). I was more worried about subarachnoid hemorrhage, but ended up picking this up. The other was a lady with a very strange headache, and partial visual loss (this one was internal carotid dissection, as opposed to VA). Both luckily did okay.

A lot of these end up being missed, or diagnosed late, because they start out as pain without neuro symptoms, then by the time the neuro symptoms develop and they're diagnosed, often the damage is already done.
 
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I always warn patients to avoid high velocity neck manipulation for this reason. I tell them if the chiro wants to use the click click "activator" on their neck it won't hurt them but it is a waste of money.
 
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