Abstract
Objective
The purpose of this article was to present a retrospective case series of patients
with symptoms and signs suggesting a stroke or prodrome and discuss the potential
for health education and promotion initiatives in chiropractic that might affect this
serious disease.
Methods
A database and hand search of records from a rural Mississippi chiropractic practice
was performed to identify all cases of patients presenting with symptoms and signs
of stroke during the past 4 years, as well as stroke mortality among active patients
during the same period.
Results
Six subjects met inclusion criteria of about 500 active patients during any given
year of the 4-year study period, including patients who had stroke symptoms or signs
(n = 4) or who died as a result of stroke without presenting to the office (n = 2).
Records and magnetic resonance angiograms were obtained after referral was made for
a 77-year-old white female, 71-year-old white male, 59-year-old white male, and 24-year-old
Hispanic female. Three of the 4 surviving patients were eventually diagnosed with
stroke, and one with seizure disorder. Common presenting complaints were unilateral
arm weakness and slurred speech; other complaints included episodic loss of vision,
dysphagia, dysphonia, and same-sided leg weakness.
Conclusions
Patients with symptoms and signs of stroke may infrequently present to chiropractic
physicians for evaluation and treatment. Prevention, screening, early identification
of stroke symptoms and signs, and referral for prompt treatment are cornerstones of
the national stroke policy as espoused by the Centers for Disease Control. Chiropractic
physicians have opportunities for practice-related health education initiatives focusing
on the role of health and wellness in stroke prevention and for prompt lifesaving
referral of emergency presentations.
Key Indexing Terms
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References
- Prevalence of Stroke—United States, 2005.MMWR Morb Mortal Wkly Rep. 2007; 56: 469-474
Barnes PM, Bloom B, Nahin R. Complimentary and alternative medicine use among adults and children: United States, 2007. CDC National Health Statistics Report #12. 2008:24.
- Complimentary and alternative medicine use among primary care patients in west Texas.South Med J. 2008; 101: 1232-1237
- Chiropractors as safety net providers: first report of findings and methods from a US survey of chiropractors.J Manipulative Physiol Ther. 2007; 30: 718-728
- Education needed on stroke symptoms and prevention.Patient Educ Manag. 2008; 6: 65-66
- Stroke following chiropractic manipulation. Report of 3 cases and review of the literature.Cerebrovasc Dis. 2002; 13: 210-213
- Misuse of the literature by medical authors in discussing spinal manipulative therapy injury.J Manipulative Physiol Ther. 1995; 18: 203-210
- Complications following vertebral manipulation-a survey of a French region physicians.Ann Readapt Med Phys. 2003; 46: 33-40
- Spinal manipulative therapy is an independent risk factor for vertebral artery dissection.Neurology. 2003; 60: 1424-1428
- Chiropractic manipulation and stroke: a population-based case-control study.Stroke. 2001; 32: 1054-1060
Lang E, Afilalo M. Vertebral Artery Dissection. In: Medscape; http://emedicine.medscape.com/article/761451-overview. Accessed May 6, 2009.
- Sporadic hypercoagulability, hemodynamic alterations, and manipulation-linked stroke.Top Clin Chiropr. 2002; 9: 21-30
Editors. Stroke. In: Online encyclopedia. www.en.wikipedia.org/wiki/stroke. Accessed May 8, 2009.
Vega J. Arterial dissection and stroke. In: About.com; http://stroke.about.com/od/causesofstroke/a/Dissection.htm. Accessed May 18, 2009.
AHA. Stroke warning signs. In: American Heart Association; http://www.americanheart.org/presenter.jhtml?identifier= 4742. Accessed Dec. 27, 2008.
- The risk of over-reporting spinal manipulative therapy-induced injuries: a description of some cases that failed to burden the statistics.J Manipulative Physiol Ther. 1996; 19: 536-538
- Clinical perceptions of the risk of vertebral artery dissection after cervical manipulation: the effect of referral bias.Spine J. 2002; 2: 334-342
- The validity of the extension-rotation test as a clinical screening procedure before neck manipulation: a secondary analysis.J Manipulative Physiol Ther. 1996; 19: 159-164
- Cerebrovascular accident without chiropractic manipulation: a case report.J Manipulative Physiol Ther. 2006; 29: 330-335
- Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study.Spine. 2008; 33: S176-S183
- Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study.J Manipulative Physiol Ther. 2009; 32: S201-S208
- Examining vertebrobasilar artery stroke in two Canadian provinces.J Manipulative Physiol Ther. 2009; 32: S194-S200
- Adverse events following chiropractic care for subjects with neck or low-back pain: do the benefits outweigh the risks.J Manipulative Physiol Ther. 2008; 31: 461-464
- Cervicogenic headaches: a critical review.Spine J. 2001; 1: 31-46
- Patterns and perceptions of care for treatment of back and neck pain: results of a national survey.Spine. 2003; 28 ([discussion 298]): 292-297
- BISIMAN study: The background incidence of stroke in manipulation in the United Kingdom.Clin Chiropr. 2008; 11: 15-22
Editors. Mississippi Stroke Death Rates. In. Atlanta: Centers for Disease Control; http://apps.need.cdc.gov/giscvh2/Results.aspx. Stroke Mortality Rate 1991-1998. Accessed May 18, 2009.
- Healthy People 2010.2nd ed. CDC, Atlanta1999 (Accessed Dec. 29, 2008)
CDC. Healthy People 2010 Focus Area 12; Heart Disease and Stroke Progress Review. In: Atlanta: CDC, 2007 power point presentation; http://www.cdc.gov/nchs/ppt/hpdata2010/focusareas/fa12_2_prog_rev.ppt. Accessed Dec. 28, 2008.
- Prescribing wellness: a case study exploring the use of health information brochures.J Manipulative Physiol Ther. 2004; 27: 262-266
- Implementation of a course on wellness concepts into a chiropractic college curriculum.J Manipulative Physiol Ther. 2005; 28: 423-428
- Chiropractic and geriatrics: a review of the training, role, and scope of chiropractic in caring for aging patients.Clin Geriatr Med. 2004; 20: 223-235
- Chiropractic in the American Public Health Association.Dynamic Chiropr. 2001; 19: 10
- A survey of US chiropractors on clinical preventive services.J Manipulative Physiol Ther. 2004; 27: 287-298
- Dietary diversity: case study of fruit and vegetable consumption by chiropractic patients.J Manipulative Physiol Ther. 2003; 26: 383-389
- Emergency nurses' knowledge of evidence-based ischemic stroke care: A pilot study.J Emerg Nurs. 2007; 33: 202-207
- Agreement between ambulance paramedic- and physician-recorded neurologic signs with face arm speech test (FAST) in acute stroke patients.Stroke. 2004; 35: 1355-1359
Article info
Publication history
Accepted:
July 29,
2009
Received in revised form:
July 29,
2009
Received:
January 18,
2009
Identification
Copyright
© 2010 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
