[Wallenberg's syndrome secondary to dissection of the vertebral artery caused by chiropractic manipulation].
BACKGROUND
Chiropractic manipulations of the cervical region are techniques that are used more and more frequently to treat a number of osteomuscular pathologies, but can give rise to important complications, such as the dissection of the cervical arteries. Dissection of the vertebral artery generally presents as alternating syndromes, of which Wallenberg s syndrome, either complete or incomplete, is the most frequent. In this paper we review the literature published to date on the pathogenesis, risk factors, clinical features, chronopathology, diagnosis, treatment and prognosis of this complication.


METHODS
We describe the case of a young patient who suffered from incomplete Wallenberg s syndrome a few hours after a single session of cervical chiropractic manipulation, and we also show the resonance images that were used to support the diagnosis.


CONCLUSIONS
The appearance of a pain in the neck and neurological symptoms in a patient who has undergone chiropractic manipulation in the last few hours or days must lead us to consider a possible dissection of the cervical arteries. Dissection of the vertebral artery usually gives rise to alternating syndromes, the most frequent of which is lateral bulbomedullary infarction or Wallenberg s syndrome due to proximal occlusion of the posteroinferior cerebellar artery. Magnetic resonance angiography of the supra aortic trunks and cranial magnetic resonance scanning are valid techniques for demonstrating the dissection of the artery and the associated ischemic lesion.
Menéndez-González
M
M
Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España. medicoresidente@yahoo.es
García
C
C
Suárez
E
E
Fernández-Díaz
D
D
Blázquez-Menes
B
B
D000328:Adult; D006801:Humans; D014854:Lateral Medullary Syndrome / Q000175:diagnosis / Q000209:etiology*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D026882:Manipulation, Chiropractic / Q000009:adverse effects*; D019838:Neck Injuries / Q000209:etiology; D014711:Vertebral Artery / Q000293:injuries* / Q000473:pathology; D020217:Vertebral Artery Dissection / Q000209:etiology*