As quoted from the American Journal of Emergency Medicine (yay EM!)
Chiropractic has grown exponentially since its inception in this country in 1896. Every year, there are more than 10 million patients who visit a chiropractor for a variety of ailments, resulting in an average of 125 million visits annually. [1] Spinal manipulation has proven helpful to many patients for a variety of complaints, and deserves a place in the therapeutic armamentarium for the treatment of musculoskeletal disorders. Chiropractic is one of the most popular alternative therapies in the United States, and there is a public perception that injuries sustained from spinal manipulation are insignificant, as well as rare. We report a case of a left pontine infarct with vertebral artery dissection, sustained after a chiropractic spinal manipulation in a previously healthy young woman.
A 33-year-old woman in good health presented to a chiropractor for treatment of a headache of several week duration. While undergoing manipulative therapy, she noted the acute onset of right-sided hemiplegia. Paramedics responding to the chiropractor's office found the patient to be alert with normal vital signs (blood pressure of 132/76 mmHg, heart rate of 86 beats/min, and a respiratory rate of 20 breaths/min). They noted complete right-sided hemiplegia, and transported her to a nearby hospital in full cervical spine precautions.
On arrival to the emergency department, the patient remained hemiplegic, and complained of a severe headache. The patient was also suffering from severe vertigo, as well as tinnitus. Her vital signs remained relatively unchanged. Physical examination revealed a well-appearing patient who was alert and cooperative. Her head and neck showed no obvious signs of trauma, and were held midline with a cervical collar. Pupils were 4 mm, equal, and reacted briskly to light. There was right-sided hyperreflexia with unilateral Babinski's sign. There was left sided facial droop, and no right-sided motor or sensory activity was appreciated. Administration of 30 mg/kg of methylprednisolone, followed by an infusion of 5.4 mg/kg/hr was given intravenously. Cervical spine radiographs were obtained which were interpreted as normal. Brain computed tomography (CT) was normal. A magnetic resonance angiography (MRA) was obtained, revealing a left pontine infarct with vertebral artery dissection.
Several weeks after the incident, the patient began to regain only minimal motor activity in her right arm. She is now in the care of a rehabilitation facility, and her neurologic deficits are only minimally improved. The technique of spinal adjustment initially used was a high cervical, high-velocity-low amplitude method (sudden thrust delivered to involved vertebrae).... Patients, chiropractors, and physicians should all be aware of the potentially devastating neurologic outcomes possible from chiropractic manipulations.
This was a healthy 33 year old Female... now with significant neurologic deficits. Food for thought.
Q, DO
