Bilateral vertebral dissection following chiropractic manipulation of the neck

Bilateral Vertebral Dissection Following Chiropractic Manipulation of the Neck: Dissection of the vertebral arteries result from blunt or penetrating neck injuries as well as abrupt active or passive movements of the head. The resulting haemodynamic changes are due to occlusion or stenosis as well as arterio-arterial embolism and can lead to vertebrobasilar ischaemia. We report on a 34-year old woman who developed neck pain, dizziness, recurrent vomiting and transient diplopia immediately after neck manipulation. MRI showed left cerebellar infarction in the territory of the posterior inferior cerebellar artery (PICA). Colour-coded duplex sonography revealed dissection of both vertebral arteries leading to 50% stenosis on the right side and occlusion on the left side. Despite anticoagulation an infarction in the medulla oblongata occurred on the eleventh day after manipulation, According to the literature bilateral dissection of the vertebral artery due to neck manipulation is rare. Unilateral dissection has been observed more frequently. This case illustrates the potentially serious consequences of chiropractic manipulation of the neck, For this reason, we think it is necessary to inform patients about possible complications before neck manipulation.