J Manipulative Physiol Ther. 2002 Nov-Dec; 25(9): 588-90.

Stroke after chiropractic manipulation as a result of extracranial postero-inferior cerebellar artery dissection.

SÃ©dat J, Dib M, Mahagne MH, Lonjon M, Paquis P.

Department of Neuroradiology, CHU de Nice, HÃ´pital St. Roch, Nice, France. [email protected]

OBJECTIVE: To describe a case of dissection of the postero-inferior cerebellar artery (PICA) after cervical manipulation. Clinical Features: After cervical manipulation, a 42-year-old woman had a cerebellar syndrome related to an infarct in the area supplied by the PICA, confirmed by computed tomography of the brain. Cerebral angiography showed a normal appearance of the vertebral artery, a cervical extradural origin of PICA, and a dissection of the latter at the C1-C2 level. Intervention and Outcome: Anticoagulant treatment with heparin was implemented. A positive outcome was achieved after 3 weeks. CONCLUSION: Anatomical variations of the vertebral arteries and their branches are not infrequent and may constitute a predisposing factor to complications after neck manipulation.