Immediate stroke following chiropractic cervical spine manipulation: a case report with causal analysis

A 27-year-old male suffered an immediate stroke after cervical spine manipulation performed by a chiropractic physician. Imaging noted bilateral vertebral artery dissection and bilateral cerebellar stroke affecting balance, coordination and speech. Craniectomy and cerebellar decompression were performed. Despite extensive occupational and speech therapy the patient suffered ongoing neurological deficits and was permanently disabled. We utilized an intuitive approach to causation analysis to determine the cause of the vertebral artery dissection, and a 3-step medicolegal causation analysis to determine the cause of the stroke. Causation of dissection by cervical spine manipulation could not be established. However, causation of immediate thromboembolic stroke by neck manipulation was established as more likely than not while considering several alternative explanations. We conclude that clinical examination strategies to exclude vertebral artery dissection prior to performing cervical spine manipulation would have prevented this unfortunate case and could prevent future cases. More training and experience for chiropractic physicians in the clinical diagnosis of vascular conditions is recommended.