J Mal Vasc. 1996 ; 21(5): 320-3.

[Manipulations of cervical vertebrae and trauma of the vertebral artery. Report of two cases]

Alimi Y, Tonolli I, Di Mauro P, Lafay V, Velut JG, Barthelemy P, Frances Y, Juhan C.

Service de Chirurgie Vasculaire, HÃ´pital Nord, Marseille.

Vertebrobasilar-distribution stroke is a rare but sometimes severe complication of chiropractic neck manipulation. We report two patients with dissections of the vertebral arteries authenticated two and six days after the cervical manipulation. In the first case, a Wallenberg's syndrome occurred due to a dissection of the right intracranial vertebral artery; the patient was treated with anticoagulant therapy but little improvement of the disorder was noted. The second patient had transitory neurologic manifestations which led to the discovery of an intimal tear of the ostium of the right vertebral artery with a floating clot. Further embolic complications were avoided by performing a venous bypass between the right common carotid and the vertebral artery at the base of the skull. Therapists should be aware of vertebrobasilar complications after spinal manipulations and should ask for early explorations (brain CT, cerebral angiography) to institute rapidly the most appropriate treatment.