Editorial Comment: Stroke Following Chiropractic Manipulation

I think this is a very interesting case with a very well done discussion of the incidence and mechanisms involved in the ischemic arterial strokes following manipulation of the neck. I have had an interest in this subject, and for that matter, the larger subject of vertebral artery distribution strokes in children since I was a resident some 40 years ago. We had a young woman in her early 20s come to the hospital with a lateral medullary infarction secondary to chiropractic manipulation of her neck when I was the senior resident on the neurology inpatient service. This led to some exploration of the literature and resulted in similar conclusions to those voiced here by Dr Deputy in that we do not know what the incidence of neurologic injury actually is. Although many of us, neurologists and child neurologists alike, have seen occasional patients with vertebral artery distribution infarcts following minor injury, trauma, or manipulation of the neck, there have been few systematic studies of the condition and the incidence is low enough that few have the experience to do such a study. The development of the pediatric stroke registry may provide sufficient numbers of cases to allow some general conclusions to be made, but so far this has not been forthcoming.
Source: Seminars in Pediatric Neurology - Category: Neurology Authors: Source Type: research