Multivessel dissection as a consequence of chiropractic cervical manipulation

Patients with headaches frequently seek relief by chiropractic measures. However, this therapy can cause cerebrovascular complications. Risk factors for arterial dissection after chiropractic neck manipulation have been discussed in several publications. This report presents the case of a female patient with a history of peripartal arterial hypertension and with a multivessel dissection discovered three weeks after a chiropractic neck manipulation.

Materials:

Duplex scan, magnetic resonance angiography.

Methods:

Analysis of duplex scan and MRA images.

Results:

Antihypertensive medication was changed to beta blocker, and anticoagulation was begun, first with heparin followed by phenprocoumon after cessation of lactation. In the follow-up examination three month later duplex and MR scan showed a total regression of the wall hematoma in the right subclavian artery; the right internal thoracic artery turned out to be normal in the MR scan.

Discussion:

Arterial dissections during pregnancy have been described in the past. They can occur in female patients with Marfan or Turner syndrome, but also in isolation. Preferential sites are the thoracic aorta, less often coronary arteries or carotid arteries. Recently, a case was reported of a pregnant woman with preeclampsia and postpartal occlusion of the left internal carotid, likely secondary to carotid dissection. In contrast, artery dissections after chiropractic neck manipulation are usually localized to the vertebral and the carotid arteries; sometimes a multivessel dissection can be found there after provoked cervical adjustment. In our case, multivessel dissection most likely occurred due to the chiropractic manoeuvres, perhaps facilitated by the postpartum state of the patient.