title: Cortex-sparing infarction in triple cervical artery dissection following chiropractic neck manipulation.
abstract: BACKGROUND
  Multivessel cervical dissection with cortical sparing is exceptional in clinical practice.
  
  
  METHODS
  A 55-year-old man presented with acute-onset neck pain with associated sudden onset right-sided hemiparesis and dysphasia after chiropractic manipulation for chronic neck pain.
  
  
  CONCLUSIONS
  Magnetic resonance imaging revealed bilateral internal carotid artery dissection and left extracranial vertebral artery dissection with bilateral anterior cerebral artery territory infarctions and large cortical-sparing left middle cerebral artery infarction. This suggests the presence of functionally patent and interconnecting leptomeningeal anastomoses between cerebral arteries, which may provide sufficient blood flow to salvage penumbral regions when a supplying artery is occluded.
  
  
  CONCLUSIONS
  Chiropractic cervical manipulation can result in catastrophic vascular lesions preventable if these practices are limited to highly specialized personnel under very specific situations.
authors.affiliation: Department of Neurology (Medicine), Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Gayane
authors.initials: G
authors.lastname: Melikyan
authors.affiliation: Department of Neurology (Medicine), Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Saadat
authors.initials: S
authors.lastname: Kamran
authors.affiliation: Department of Neurology (Medicine), Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Naveed
authors.initials: N
authors.lastname: Akhtar
authors.affiliation: Department of Neurology (Medicine), Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Dirk
authors.initials: D
authors.lastname: Deleu
authors.affiliation: Department of Neurology (Medicine), Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Francisco Ruiz
authors.initials: FR
authors.lastname: Miyares
keywords: chiropractics; cortical sparing; magnetic resonance imaging; stroke; trivessel dissection
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