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Chiropractic Research Review

Cervical Artery Dissection: The Basics

Cervical artery dissection most commonly occurs in the vertebrobasilar artery, but can sometimes appear in the carotid artery. Dissection of these arteries is a controversial topic in chiropractic and medical literature due to the fact that chiropractors adjust the upper cervical spine - neurologists caution that torsion of the neck is dangerous to the vertebrobasilar artery.

The carotid is less often involved because it is more mobile than the vertebrobasilar artery.

This study reviews the basic anatomy, neurology, and risk factors associated with vertebrobasilar dissection, and relates the problem to chiropractic manipulation. The article was published recently after two deaths following manipulation.

Evidence of injury to the vertebro- basilar artery almost always occurs at the C1-C2 level of the spine, while carotid artery damage is more common below C2. The patterns of stroke for each artery are different. Carotid artery dissections result in hemiparesis, hemisensory loss, and other cerebral hemispheric losses in neurological function. Vertebrobasilar dissections more commonly result in ataxia and quadriparesis.
The authors present an overview of the appropriate diagnosis and follow-up of stroke patients, and discuss the potential for spontaneous dissection. In addition, clinical features from 74 strokes reported by the Canadian Stroke Consortium in the previous year are presented.

Note: The complete text of this study is available free at http://www.cma.ca/cmaj/vol-163/issue-1/0038.htm.

Norris JW, Beletsky V, Nadareishvili ZG. Sudden neck movement and cervical artery dissection. Canadian Medical Association Journal 2000:163(1), pp. 38-40.

Chiropractic Research Review

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