Lateral medullary syndrome post-chiropractic manipulation in a 25-year old female with headache

Cervical chiropractic manipulation for the treatment of back and neck pain is becoming increasingly commonplace, especially amongst younger adults. It may also give rise to serious complications, such as dissection of cervical arteries with resultant stroke syndromes. This case report reviews the literature surrounding this issue and highlights the importance of correctly diagnosing cerebrovascular pathology in young adults. We describe the case of a 25-year-old female with delayed onset of focal neurology and lateral medullary syndrome post-chiropractic cervical manipulation. Magnetic resonance angiogram and computed tomography angiogram confirm lateral medullary infarction and bilateral vertebral artery dissection. Currently, chiropractic manipulation and complications are a relatively topical issue and some of the potential serious complications are discussed in this case. Certain posterior circulation stroke symptoms belong to distinct clinical syndromes and it is important to be aware of these when assessing patients with possible posterior circulation ischemia. This is especially important in younger populations, where misdiagnosis as migraine may be a common pitfall. Headache and focal neurology following chiropractic cervical manipulation should be managed and investigated with a high index of suspicion for vertebral artery dissection.>