COMMENTARY

Does Chiropractic Care Increase Stroke Risk?

Mark J. Alberts, MD

Disclosures

May 01, 2012

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Hello there, and welcome to this Medscape stroke update. My name is Mark Alberts, head of the stroke program at Northwestern University in Chicago. Today I want to talk about a very vexing and important topic. The logic is as follows: We know that dissections, or tearing of either the carotid or vertebral arteries in the neck, have sometimes been associated with what we call cervical or neck manipulation, particularly a chiropractic type of neck manipulation. There have been some reports of these associations in the literature, saying that spinal or neck manipulation may increase the risk for arterial dissection in the neck and perhaps even increase the risk for this dissection leading to a stroke.[1]

These studies are somewhat complicated to understand because a main reason that someone might go to have their neck manipulated is neck pain. In fact, neck pain is one of the most common presentations of an arterial dissection in the neck, so at the end of the day it is very hard to tell whether these dissections are caused by a chiropractic neck manipulation or whether the dissection was preexisting and maybe the neck manipulation worsened it. To sort this out would be very complex from a clinical trial point of view. Having said that, many people (including myself) have seen patients who had no neck pain before they went for a routine chiropractic neck manipulation and then experienced immediate onset of sudden severe neck pain followed by a stroke in a few minutes, hours, or days. In that circumstance, it is at least easier to believe that there may be a clear cause-and-effect relationship between neck manipulation and the production of a dissection and a stroke. Those cases are relatively few and far between, but they can certainly occur.

At this point, it is safe to say that there may be an association between chiropractic neck manipulation and the production of an arterial dissection and a stroke. How commonly that occurs and the difference between association and causation can really only be proven by large prospective trials that will probably never be done. My general word of advice is that if a patient is prone to cervical dissections and has a family history of cervical dissections, the patient should protect his or her neck and avoid chiropractic neck manipulation as well as roller coasters, bungee cord jumping, and skydiving. The neck is very valuable real estate, so patients should do what they can to protect it. Thank you for joining me for this Medscape stroke update.

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