I was recently asked to comment on a case involving a person who presented to a chiropractor’s office after a motor vehicle accident and ended up with a vertebral artery dissection and stroke. As a vascular neurologist I see all kinds of stroke’s including those caused by vertebral artery dissection. From my perspective it is presumptive to say that chiropractors are the cause of this form of dissection and stroke. The literature is limited in causality due to the fact that vertebral artery dissection is seemingly rare. Of the many causes, trauma appears to be number one and of these motor vehicle accidents rises to the top.
Often people seek chiropractic care after a motor vehicle accident due to neck and back pain. It is unclear whether neck manipulation is the cause or whether the patient had a pre-existing dissection from the mechanical injury from the accident. I believe that chiropractors are an integral component of patient care and have been unjustly criticized for their role in posterior circulation strokes due to the lack of evidence for such events. I have several patients that I have identified as having a pre-existing dissection or blockage prior to their visit to the chiropractor that likely led to their stroke around the time of their neck manipulation. I make every effort to make chiropractic care a part of my management plan for my patients with neck and back pain and as a result of this collaborative effort I have developed professional relationships with several chiropractors in coordinating care. Most recently this collaboration has included developing a protocol with Dr Gerry Clum, Former President of Life Chiropractic College West, to help determine the etiology for vertebral artery dissections.
The protocol entails utilizing vascular ultrasound in evaluating the integrity of the posterior circulation prior to neck manipulation. This is done in hopes of identifying those patients who may be at a higher risk of dissection based on whether there is already an arterial blockage or an arterial wall tear. We can also identify those patients who have a tight vertebral artery canal that could predispose one to dissection or ischemia with certain neck maneuvers. Given that vertebral artery strokes are rare we have concluded that a very large amount of patients will be needed to ascertain cause and effect. This is why we are asking for your help in this project. We will likely need as many participants as possible to make this as credible as possible. I would like nothing more than to have some definitive data to help put to rest the innuendo and hyperbole that accompany chiropractic care and stroke. The data would also help me in commenting on legal cases such as the one mentioned above that has further drawn my attention to this topic. We believe that the information provided from the study would be a substantial benefit to patient care and hopefully help determine who may or may not be at risk of posterior circulation ischemia from certain neck manipulations.
We have acquired a powerful portable ultrasound machine that could travel at a moment’s notice to your clinic and perform the necessary tests within just a few minutes. This hopefully would result in helpful information in treating your patients and not result in any disruption of care. We would like to include as many patients as possible who have been in a motor vehicle accident and for whom neck manipulation has been determined to be a part of their management plan. We would like to categorize patients with neurological symptoms to help determine if certain symptoms have a higher risk for stroke. Such symptoms include but are not limited to nausea, lateralizing neck pain, dizziness, vertigo, numbness or tingling of the face arm or leg, visual changes, and headache.
We would really appreciate your help in this project. Please contact me or Dr Clum for further information or if you would like to participate. Public and private insurance coverage, including MVA and PIP, for the procedure is justified based on the above focal neurological symptoms as TIA or stroke is suspected.
If you have a patient that you would like to enter please page 206-469-0298. We are able to be onsite at your clinic and finish the test within minutes. We are also prepared to reimburse your clinic for the time and space used in performing the test.
Aaron Heide, MD
Board Certified Vascular Neurologist
Nevada Neurology and Vascular Center LLC
Gerry Clum, DC
Life Chiropractic College West
510-780-4500 ext. 4550