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 The blood vessel tears, called ‘cervical artery dissections’ account
for about two of every 100 strokes overall, and from eight to 25 of
every 100 strokes in young and middle aged adults.
“What happens with the dissection is that there is a tear in one of
the layers of the artery wall in the neck that can result in (a)
stroke if a blood clot forms,” Dr. José Biller told Reuters Health
in a phone call.
Biller, a neurologist with the Loyola University Chicago Strich
School of Medicine, was lead author of a joint statement on neck
manipulation and stroke risk from the American Heart Association and
the American Stroke Association. The statement was published in
Stroke.
Biller said cervical artery dissections have been reported after
blunt or penetrating injuries and also in association with a variety
of other conditions.
They can occur after “a sudden movement that can hyperextend or
rotate the neck that may happen with certain sporting activities,
with whiplash or violent coughing or vomiting movements, or with
neck manipulation therapy,” Biller said.
Healthcare providers sometimes use neck manipulations, or “cervical
manipulative therapy,” to treat musculoskeletal conditions of the
neck and upper back. Most are performed by chiropractors, but
osteopaths and physical therapists use these maneuvers as well.
To assess the associations between neck manipulations and stroke
risk, Biller and colleagues focused on four large studies that were
mainly associated with strokes involving the arteries of the neck.
They found that people who had these types of strokes were more
likely to have had some type of neck manipulation.
But, the authors point out, the studies they looked at couldn’t
determine what caused people’s strokes. It’s possible, they say,
that people may have sought neck manipulation therapy for symptoms
that were really the early stages of stroke.
Biller said patients with these tears often have pain in the back of
the neck that may be misinterpreted by both the patient and a
healthcare provider.
“Patients may already have begun to have a cervical artery
dissection and therefore seek treatment to relieve the neck pain.”
Biller and his coauthors concluded that health practitioners should
inform patients of the associations between cervical dissection and
cervical manipulation therapy before performing manipulation of the
cervical spine.
Keith Overland, immediate past president of the American
Chiropractic Association, told Reuters Health he applauds the
American Heart Association for its effort to address stroke risk.
But, he said, somewhere between 22 and 77 percent of the U.S.
population has neck pain at some time, and cervical manipulation is
one of the safest choices when compared to other treatments such as
drugs and surgery.
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Dr. Justin Sattin, a neurologist with the University of Wisconsin
School of Medicine and Public Health in Madison, Wisconsin, told
Reuters Health by phone, “As the guideline points out, the data are
inconclusive - my personal opinion is that cervical manipulation is
probably one of many different traumas that could provoke or
exacerbate a dissection in someone who is harboring one or
predisposed.”
“Having said that, the absolute risk is probably low, especially
with increased attention to the problem now in the chiropractic
community,” said Sattin, who was not involved with the study.
“And there’s this causality issue of how do you know for sure the
manipulation was the cause as opposed to the idea that the headache
and neck pain that brought the patient to the chiropractor was
actually the dissection, and the subsequently diagnosed dissection
was attributed to the manipulation as opposed to something that
occurred spontaneously or due to some other trauma that preceded the
patient coming in for medical attention,” he said.
Sattin added that it’s difficult to tease these things out of the
results, but he thinks it's fair to say there is some evidence that
cervical manipulation maybe a potential cause dissection and that
patients should know that when they go to see a chiropractor and the
chiropractor should know that and disclose it to the patients.
“That doesn't mean one shouldn't pursue chiropractic therapy, it’s
just incumbent on everybody to know what the actual risks are. It’s
not like (regular) medicine is devoid of risks either. Everything we
do carries potential risks and benefits,” he said.
“In general, stroke symptoms happen suddenly —a sudden onset of
weakness on one side of the body, numbness on one side of the body
or tingling, visual loss which could be in one eye or to one side of
one's visual field, sudden loss of coordination, sudden onset of a
language disturbance - either difficulty speaking or difficulty
understanding what's being said,” Sattin said.
“And the last one that we usually see is the sudden onset of a
terrible headache unlike any headache of the persons had before,
which is a cardinal symptom for hemorrhage in the brain,” he added.
Sattin added that symptoms for a stroke due to dissection may
include pain in the head or neck, or sometimes behind the eye, along
with the other neurological symptoms of stroke.
SOURCE: http://bit.ly/XcnXHM
Stroke, online August, 7, 2014.
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