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Neck Manipulation & Stroke Risk

Neck Manipulation & Stroke Risk

Cervical dissections (CD) of the arteries—small tears in the layers of the arterial walls in the neck—are an important cause of stroke in young and middle-aged patients. CD can result in ischemic stroke if blood clots form after a trivial or major trauma in the neck and later cause blockages to the blood vessels in the brain. “CD accounts for just 2% of all ischemic strokes but 8% to 25% of strokes in patients younger than age 45,” says José Biller, MD, FAAN, FACP, FAHA. “The annual incidence, however, is likely underestimated because asymptomatic CD often goes undiagnosed.” Currently, the underlying pathology for spontaneous CD is unknown, but several factors have been linked to CD (Table 1). Dissections can be either spontaneous or traumatic, and their severity can vary. Research has shown that mechanical forces often play a role in a considerable number of CDs. “Most dissections involve some form of trauma, stretching, or mechanical stress,” says Ralph L. Sacco, MD, MS, FAHA, FAAN. These dissections can also occur with cervical manipulative therapy (CMT), various sporting activities, whiplash injuries, sudden neck movements, and violent vomiting or coughing, even if these events are deemed inconsequential by patients. Although CMT techniques vary, maneuvers often extend and rotate the neck, and some involve a forceful thrust. New Recommendations In 2014, the American Heart Association (AHA) released a scientific statement on CD and its association with CMT. “The statement reviews the current state of evidence on diagnosing and managing CDs and their statistical association with CMT,” says Dr. Sacco, who co-chaired the AHA writing committee that developed the scientific statement. “The association between...
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