title: Vertebral artery dissections after chiropractic neck manipulation in Germany over three years.
abstract: Vertebral artery dissection (VAD) has been observed in association with chirotherapy of the neck. However, most publications describe only single case reports or a small number of cases. We analyzed data from neurological departments at university hospitals in Germany over a three year period of time of subjects with vertebral artery dissections associated with chiropractic neck manipulation. We conducted a country-wide survey at neurological departments of all medical schools to identify patients with VAD after chirotherapy followed by a standardized questionnaire for each patient. 36 patients (mean age 40 + 11 years) with VAD were identified in 13 neurological departments. Clinical symptoms consistent with VAD started in 55% of patients within 12 hours after neck manipulation. Diagnosis of VAD was established in most cases using digital subtraction angiography (DSA), magnetic resonance angiography (MRA) or duplex sonography. 90% of patients admitted to hospital showed focal neurological deficits and among these 11 % had a reduced level of consciousness. 50% of subjects were discharged after 20 +/- 14 hospital days with focal neurological deficits, 1 patient died and 1 was in a persistent vegetative state. Risk factors associated with artery dissections (e. g. fibromuscular dysplasia) were present in only 25% of subjects. In summary, we describe the clinical pattern of 36 patients with vertebral artery dissections and prior chiropractic neck manipulation.
authors.affiliation: Charité-Universitätsmedizin Berlin, Department of Neurology, Schumannstrasse 20-21, 10098 Berlin, Germany. uwe.reuter@charite.de
authors.forename: U
authors.initials: U
authors.lastname: Reuter
authors.forename: M
authors.initials: M
authors.lastname: Hämling
authors.forename: I
authors.initials: I
authors.lastname: Kavuk
authors.forename: K M
authors.initials: KM
authors.lastname: Einhäupl
authors.forename: E
authors.initials: E
authors.lastname: Schielke
mesh_terms: D000328:Adult; D002684:Chiropractic / Q000009:adverse effects*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000503:physiopathology*; D009422:Nervous System Diseases / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors; D020217:Vertebral Artery Dissection / Q000453:epidemiology* / Q000209:etiology*