Dissection of the internal carotid artery after mobilization of the cervical spine – Bad luck or grave error in treatment

A 46-year-old female presented at an ENT specialist's practice due to increasing cervical spine complaints and a temporomandibular joint problem. A mobilization of the cervical spine was performed. As a direct result, the patient suffered from circulatory dysregulation. The subsequent diagnostics in the clinic revealed acute ischemia in the cerebral artery flow area due to an extradural ACI dissection on the left. The MDK certified a grave error in treatment. A cervical spine fracture with osteosynthetic treatment years before this event is documented in the detailed medical history. Cervical artery dissection (CAD) is a tear or hematoma in the wall of the internal carotid artery or the vertebral artery (Debette, 2014). According to recent studies, CAD is responsible for up to 25% of all ischemic strokes in people under 55 years of age and 2% of all ischemic strokes. It occurs spontaneously or often after (minor) trauma (Debette, 2014). Looking at the causality in the present case, medical malpractice due to manipulation would indeed be conceivable, which either simultaneously led to a deflection of the cervical spine or direct pressure via the tonsillar fossa on the internal carotid artery occurred due to incorrect thumb position, or a dissection of the carotid artery already existed, which was undetected up to this point and the clinic occurred coincidental to time but independent of mobilization. What is the most likely hypothesis in the present case and how complex this extensive case is will be discussed during the presentation.

Publication History

Article published online:
19 April 2024