Stroke after chiropractic manipulation as a result of extracranial postero-inferior cerebellar artery dissection.

OBJECTIVE

To describe a case of dissection of the postero-inferior cerebellar artery (PICA) after cervical manipulation.

CLINICAL FEATURES: After cervical manipulation, a 42-year-old woman had a cerebellar syndrome related to an infarct in the area supplied by the PICA, confirmed by computed tomography of the brain. Cerebral angiography showed a normal appearance of the vertebral artery, a cervical extradural origin of PICA, and a dissection of the latter at the C1-C2 level.

INTERVENTION AND OUTCOME: Anticoagulant treatment with heparin was implemented. A positive outcome was achieved after 3 weeks.

CONCLUSION

Anatomical variations of the vertebral arteries and their branches are not infrequent and may constitute a predisposing factor to complications after neck manipulation.