title: Changes in cerebellar blood flow after manipulation of the cervical spine using Technetium 99m-ethyl cysteinate dimer.
abstract: BACKGROUND
  Cervical spine manipulation is one of the many interventions practiced by health professionals to treat musculoskeletal disorders of the cervical spine. Although serious consequences of manipulation have been documented, the incidence is thought to be rare. More frequently, there may be minor transient side effects after manipulation of the cervical spine, such as headache, dizziness, and nausea. One of the hypothesis is that these side effects are caused by ischemia in the areas perfused by the vertebral arteries.
  
  
  OBJECTIVE
  The purpose of this study was to investigate whether manipulation of the cervical spine can influence blood flow in the brain.
  
  
  METHODS
  Single photon emission computed tomography was used to examine changes in regional cerebral blood flow caused by cervical spine manipulation (CSM) performed by a physiotherapist to 15 volunteers, using a 1-day split-dose Technetium 99m-ethyl cysteinate dimer single photon emission computed tomography activation paradigm.
  
  
  RESULTS
  One brain region was identified showing a decreased regional cerebral blood flow after manipulation. This region was situated in the anterior lobe of the left cerebellum (-42, -48, -24).
  
  
  CONCLUSIONS
  These findings suggest that cerebellar hypoperfusion may occur after CSM. This could explain why certain people experience headache, dizziness, or nausea after CSM. Further investigation into patient symptoms in the presence of cerebellar hypoperfusion and the possible link of these findings with other adverse reactions are warranted.
authors.affiliation: Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium. barbara.cagnie@ugent.be
authors.forename: Barbara
authors.initials: B
authors.lastname: Cagnie
authors.forename: Filip
authors.initials: F
authors.lastname: Jacobs
authors.forename: Erik
authors.initials: E
authors.lastname: Barbaix
authors.forename: Elke
authors.initials: E
authors.lastname: Vinck
authors.forename: Rudi
authors.initials: R
authors.lastname: Dierckx
authors.forename: Dirk
authors.initials: D
authors.lastname: Cambier
mesh_terms: D000328:Adult; D002531:Cerebellum / Q000098:blood supply* / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D003545:Cysteine / Q000031:analogs & derivatives*; D006801:Humans; D026882:Manipulation, Chiropractic; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012039:Regional Blood Flow
chemical_list: D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C059659:technetium Tc 99m bicisate; D003545:Cysteine