title: Motor vehicle accidents: the most common cause of traumatic vertebrobasilar ischemia.
abstract: BACKGROUND
  Recent media exposure of strokes from chiropractic manipulation have focused attention on traumatic vertebrobasilar ischemia. However, chiropractic manipulation, while the easiest cause to recognize, is probably not the most common cause of this condition.
  
  
  METHODS
  We reviewed all consecutive cases of traumatic vertebrobasilar ischemia referred to a single neurovascular practice over 20 years, from the office files and hospital records.
  
  
  RESULTS
  There were 80 patients whose vertebrobasilar ischemia was attributed to neck trauma. Five were diagnosed as due to chiropractic manipulation, but the commonest attributed cause was motor vehicle accidents (MVAs), which accounted for 70 cases; one was a sports injury, and five were industrial accidents. In some cases neck pain from an MVA led to chiropractic manipulation, so the cause may have been compounded. In most vehicular cases the diagnosis had been missed, even denied, by the neurologists and neurosurgeons initially involved. The longest delay between the injury and the onset of delayed symptoms was five years.
  
  
  CONCLUSIONS
  Traumatic vertebrobasilar ischemia is most often due to MVAs; the diagnosis is often missed, in part because of the delay between injury and onset of symptoms and, in part, we hypothesize, because of reluctance of doctors to be involved in medicolegal cases.
authors.affiliation: Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Beaudry
authors.forename: J David
authors.initials: JD
authors.lastname: Spence
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology