A Cervical Spine Manipulation-associated Dissection of Basilar Artery – a Case Report

Authors: M. Tinková 1;  J. Kasík 1;  J. Lacman 2
Authors‘ workplace: ÚVN Praha Neurologické oddělení 1;  ÚVN Praha Radiodiagnostické oddělení, LF UK v Hradci Králové 2
Published in: Cesk Slov Neurol N 2011; 74/107(3): 348-352
Category: Case Report


The authors present the case of a 37-year-old female who presented with severe acute dizziness with subsequent neurological deficit. A diagnosis of basilar artery occlusion was made and successfully treated with acute stenting.Vertebrobasilar dissection after manipulation of the cervical spine is a rare complication of this therapeutic modality. The exact incidence of vertebrobasilar dissection and subsequent stroke is not known. The significant worsening of neck pain and the onset of neurological symptoms after the manipulation indicates urgent neurological examination. CT angiography (CTA) is the most available imaging method in the diagnostics of basilar artery occlusion. Diffusion-weighted MRI (DWI) in combination with perfusion- weighted MRI (PWI) has proved wisely useful in the selection of patients suitable for acute therapy, should a mismatch between these procedures suggest viable penumbral tissue. A diagnosis of occlusion of the basilar artery is a strong indication for urgent endovascular intervention.

Key words:
dissection of vertebral artery – Wallenberg syndrome – thrombosis of basilar artery


1. Rothwell DM, Bondy SJ, Williams JI. Chiropractic manipulation and stroke: a population-based case control study. Stroke 2001; 32(5): 1054–1060.

2. Leon-Sanchez A, Cuetter A, Ferrer G. Cervical spine manipulation: An alternative medical procedure with potentially fatal complications. South Med J 2007; 100(2): 201–203.

3. Licht PB, Christensen HW, Hoilund-Carlsen PF. Is cervical spinal manipulation dangerous? J Manipulative Phys Ther 2003; 26(1): 48–52.

4. Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 2001; 344(12): 898–903.

5. Thiel HW, Bolton JE. Predictors for immediate and global responses to chiropractic manipulation of the cervical spine. J Manipulative Physiol Ther 2008; 31(3): 172–183.

6. Cassidy JD, Boyle E, Coté P, Yaohua H, Hogg-Johnson S, Silver FS. Risk of vertebrobasilar stroke and chiropractic care. Spine 2008; 33 (Suppl 4): 176–183.

7. Schellhas KP, Latchaw RE, Wendling LR, Gold LHA. Vertebrobasilar injuries following cervical manipulation. JAMA 1980; 244(13): 1450–1453.

8. Drábek P, Majvald Č. Disekce vertebrálních tepen. Cesk Slov Neurol N 1992; 55/88(2): 121–125.

9. Ford GA. Intra-arterial thrombolysis is the treatment of choice for basilar thrombosis. Stroke 2006; 37(9): 2438–2439.

10. Tichý J. Trombóza a embolie bazilární tepny. Praha: Avicenum 1983: 46–85.

11. Lindsberg PJ, Mattle HP. Therapy of basilar artery occlussion. A systematic analysis comparing intra-arterial and intravenous thrombolysis. Stroke 2006; 37(3): 922–928.

12. Vacek J, Pohanka M. Vertebrobazilární komplikace při manipulační léčbě krční páteře. Rehabil Fyz Lék 2009, 16(1): 16–20.

13. Smith WS. Intra-arterial thrombolytic therapy for acute basilar occlusion. Stroke 2007; 38 (Suppl 2): 701–703.

14. Schonewille WJ. Outcome in patients with basilar artery occlusion treated conventionally. J Neurol Neurosurg Psychiatry 2005; 76(9): 1238–1241.

15. European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008, 25(5): 457–507.

16. Pfefferkorn T, Holtmannspotter M, Schmidt C, Bender A, Pfister HW, Straube A et al. Drip, ship, and retrieve. Cooperative recanalisation therapy in acute basilar artery occlusion. Stroke 2010; 41(4): 722–726

17. Davis SM, Donnan GA. Basilar artery thrombosis: recanalisation is the key. Stroke 2006; 37(9): 2440.

18. Nagel S, Schellinger PD, Hartmann M, Suettler E, Bittner HB, Ringleb P. Therapy of acute basilar artery occlusion. Stroke 2009; 40(1): 140–146.

19. Nogueira RG, Schwamm LH, Buonanno FS, Koroshetz WJ, Yoo AJ, Rabinov JD et al. Low-pressure ballon angioplasty with adjutant pharmacological therapy in patients with acute ischemic stroke cause by intracranial arterial occlusions. Neuroradiology 2008; 50(4): 331–340.

20. Eckert B, Koch CH, Thomalla G, Kucinski T. Aggressive therapy with intravenous abciximab and intra-arterial rtPA and additional PTA/Stenting improves clinical outcome in acute vertebrobasilar occlusion. Stroke 2005; 36(6): 1160–1165.

21. Raphaeli G, Eichel R, Ben-HurT, Leker RR, Cohen JE. Multimodal reperfusion therapy in patients with acute basilar artery occlusion. Neurosurgery 2009; 65(3): 548–553.

Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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2011 Issue 3

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