Case Report| Volume 29, ISSUE 4, P330-335, May 2006

Download started.


Cerebrovascular Accident Without Chiropractic Manipulation: A Case Report

  • Annabel L. Kier
    Submit requests for reprints to: Annabel L. Kier, DC, Welsh Institute of Chiropractic, School of Applied Sciences, University of Glamorgan, Pontypridd, Rhondda Cynon Taf, CF37 1DL Wales, UK.
    Senior Lecturer, Welsh Institute of Chiropractic, School of Applied Sciences, University of Glamorgan, Pontypridd, Rhondda Cynon Taff, Wales, UK
    Search for articles by this author
  • Peter W. McCarthy
    Reader Welsh Institute of Chiropractic, School of Applied Sciences, University of Glamorgan, Pontypridd, Rhondda Cynon Taff, Wales, UK
    Search for articles by this author


      To discuss the case of a patient with chronic headache. Although not in severe pain at time of consultation, signs and symptoms raised concern. The patient later had a cerebrovascular accident.

      Clinical Features

      A 49-year-old man with non-traumatic chronic episodic head and neck pain presented for care. Examination and plain film radiographs were unremarkable, suggesting a mechanical origin for the symptoms; however, information in the case history raised concerns.

      Intervention and Outcome

      The patient was examined and not manipulated by the doctor of chiropractic but referred back to his general practitioner for a second opinion. The following week, the patient was admitted to hospital having had a cerebrovascular accident.


      The possible indication of the prodrome to a stroke may lie in the case history rather than the examination findings and provocative testing.

      Key Indexing Terms

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Manipulative & Physiological Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bronfort G
        • Nilsson N
        • Haas M
        • Evans R
        • Goldsmith CH
        • Assendelft WJJ
        • et al.
        Non-invasive physical treatments for chronic/recurrent headache.
        Cochrane Database Syst Rev. 2004; : CD001878
        • Licht PB
        • Christensen HW
        • Høilund-Carlsen PF
        Is cervical spinal manipulation dangerous?.
        J Manipulative Physiol Ther. 2003; 26: 48-52
        • Terrett A
        Vertebrobasilar complications following spinal manipulations.
        2nd ed. NCMIC Group, Inc, Des Moines2001
        • Rothwell D
        • Bondy S
        • Williams I
        Chiropractic manipulation and stroke: a population-based case-control study.
        Stroke. 2001; 32: 1054-1060
        • d'Anglejan-Chatillon J
        • Ribeiro V
        • Mas JL
        • Bousser MG
        • Laplane I
        Dissection of the extracranial internal carotid artery: 62 cases.
        Presse Med. 1990; 19: 661-667
        • Hosoya T
        • Adachi M
        • Yamaguchi K
        • Tamami H
        • Takamasa K
        • Takeo K
        Clinical and neuroradiological features of intracranial vertebrobasilar artery dissection.
        Stroke. 1999; 30: 1083-1090
        • Mann T
        • Refshauge KM
        Causes of complications from cervical spine manipulation.
        Aust J Physiother. 2001; 47: 255-266
        • Haldeman S
        • Kohlbeck FJ
        • McGregor M
        Risk factors and precipitation neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation.
        Spine. 1999; 24: 785-794
        • Breen A
        Manipulation of the neck and stroke: time for more rigorous evidence.
        Med J Aust. 2002; 176: 364-365
        • Rosner A
        Spontaneous cervical artery dissection: another perspective.
        J Manipulative Physiol Ther. 2004; 27: 124-132
        • Beatriz LR
        • d'Agostino R
        • Abbott RD
        • Kagan A
        • Burchfield CM
        • Yano K
        • et al.
        Risk of hospitalized stroke in men enrolled in the Honolulu Heart Program and the Framingham Study. A comparison of incidence and risk factor effect.
        Stroke. 2002; 33: 230-237
        • Klougart N
        • Leboeuf Yde C
        • Rasmussen LR
        Safety in chiropractic practice, Part I; The occurrence of cerebrovascular accidents after manipulation to the neck in Denmark from 1978-1988.
        J Manipulative Physiol Ther. 1996; 19: 371-377
        • Licht PB
        • Christensen HW
        • Høilund-Carlsen PF
        Vertebral artery volume flow in human beings.
        J Manipulative Physiol Ther. 1999; 22: 363-367
        • Licht PB
        • Christensen HW
        • Høilund-Carlsen PF
        Is there a role for pre-manipulative testing before cervical manipulation?.
        J Manipulative Physiol Ther. 2000; 23: 175-179
        • Symons BP
        • Leonard T
        • Hertzog W
        Internal forces sustained by the vertebral artery during spinal manipulative therapy.
        J Manipulative Physiol Ther. 2002; 25: 504-510
        • Canadian Chiropractic Association
        Regarding the recommendations of the jury in the inquest into the death of Lana Lewis convened by the office of the Coroner, Ontario.
        The Association, Toronto2004 (Available from:$file/97-March+25+2004+Recommendations+Response.pdf)
        • Treleaven J
        • Jull G
        • Sterling M
        Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error.
        J Rehabil Med. 2003; 35: 36-43
        • Lee WW
        • Jensen ER
        Bilateral internal carotid artery dissection due to trivial trauma.
        J Emerg Med. 2000; 19: 35-41
        • Saeed A
        • Shuaib A
        • Al-Sulaiti G
        • Emery D
        Vertebral artery dissection: warning symptoms, clinical features and prognosis in 26 patients.
        Can J Neurol Sci. 2000; 27: 292-296
        • Krespi Y
        • Gurol ME
        • Coban O
        • Tuncay R
        • Bahar S
        Vertebral artery dissection presenting with isolated neck pain.
        J Neuroimaging. 2002; 12: 179-182
        • Jousilahti P
        • Tuomilehto J
        • Rastenyte D
        • Vartiainen E
        Headache and the risk of stroke: a prospective observational cohort study among 35,056 Finnish men and women.
        Arch Intern Med. 2003; 163: 1058-1062
        • Dodick D
        Thunderclap headache.
        Headache. 2002; 42: 309
        • Witham TF
        • Kaufmann AM
        Unruptured cerebral aneurysm producing a thunderclap headache.
        Am J Emerg Med. 2000; 18: 88-90
        • Anonymous
        Thunderclap headache. Subarachnoid haemorrhage.
        N Z Med J. 2005; 118: U1326
        • Sturzenegger M
        Headache and neck pain: the warning symptoms of vertebral artery dissection.
        Headache. 1994; 34: 187-193
        • Haneline M
        • Croft AC
        • Frishberg BM
        Association of internal carotid artery dissection and chiropractic manipulation.
        Neurologist. 2003; 9: 35-44
        • Depeyron A
        • Vautravers P
        • Lecocq J
        • Isner-Horobeti ME
        Complications following vertebral manipulation—a survey of French region physicians.
        Ann Readapt Med Phys. 2003; 46: 33-40
        • Latronico N
        • Fassini P
        • Antonini B
        • Gasparotti R
        A pain in the neck.
        Lancet. 2002; 359: 1206
        • Rubinstein SM
        • Haldeman S
        Cervical manipulation to a patient with a history of traumatically induced dissection of the internal carotid artery: a case report and review of the literature on recurrent dissections.
        J Manipulative Physiol Ther. 2001; 24: 520-525
        • Gross AR
        • Hoving JL
        • Haines TA
        • Goldsmith CH
        • Kay T
        • Aker P
        • et al.
        Manipulation and mobilisation for mechanical neck disorders.
        Cochrane Database Syst Rev. 2004; : CD004249
        • Hurwitz EL
        • Morgenstern H
        • Vassilaki M
        • Chiang LM
        Adverse reactions to chiropractic treatment and their effects satisfaction and clinic outcomes among patients enrolled in UCLA Neck Pain Study.
        J Manipulative Physiol Ther. 2004; 27: 16-25