"Vertebrobasilar Stroke Caused by Chiropractic Manipulation: The Diagnosis and Treatment

I was only thirty years old, I was sitting in the emergency room and I was having a vertebrobasilar stroke following a chiropractic neck manipulation. June 9, 1992 was a day I would never forget; it was the day I was saved by a brand new life-saving procedure for treating stroke. It was a miracle.

As I detailed in my previous article, after having my neck adjusted by a chiropractor, I was literally dying from a vertebrobasilar stroke as I waited in the Emergency Room. After a chiropractic neck manipulation the day before, I immediately began having the typical stroke warning signs. In the chiropractor's office, I had the onset of a sudden and severe headache, I had troubling walking, and I was dizzy and losing coordination. Unfortunately, my chiropractor was not only unaware of the incidence of stroke following neck manipulation; he was also woefully ignorant of these basic stroke warning signs.

The chiropractor had sent me home the day before with his cell phone number and instructions to rest and take Tylenol for the headache. After calling him three times, he continued to assure me that this could occur following a neck manipulation. Being healthy and thirty, I believed I had a pinched nerve in my neck caused by the manipulation. Overnight, the symptoms worsened and by morning I could not stand and my speech was slurred. Finally, we realized I was stroking and headed immediately to the emergency room.

Now, as I sat in the emergency room, I knew I was going to die. Initially, medical personnel believed I had taken some sort of illicit drug and was having a really bad reaction. Even though my symptoms were classic stroke symptoms, I was only thirty and therefore not the obvious stroke victim. Fortunately, my father called a neurologist who was highly recommended by a physician friend. Making rounds at another hospital, he called and spoke to the resident responsible for my care. The minute the neurologist learned I had received a chiropractic neck manipulation the day before, he told the hospital staff to admit me because I was having a stroke. This neurologist knew of the connection between chiropractic neck manipulation and vertebrobasilar stroke, even when the chiropractor did not.

By this point, I was beginning to float in and out of consciousness. I was taken to interventional radiology for an angiogram. A thin catheter was inserted into my femoral artery and a contrast agent (x-ray dye) was injected to look for clots. Initially checking my carotid arteries, no blockages were seen. Upon further inspection, the radiologist saw something further back. A huge clot was found in my basilar artery.

Now we understood what had happened to me. The chiropractor manipulated my neck, dissecting my vertebral artery. This means that the chiropractor stretched and sharply twisted my neck and in doing do stretched and crushed my vertebral artery. Slowly, blood built up where the artery was crushed and clotted in my vertebral artery causing me to exhibit the symptoms of stroke: severe headache, dizziness and lack of coordination. Finally, when I had felt the sharp pain and heard the electrical buzzing sound in bed the prior night, the clot had broken off and traveled to my basilar artery. The stroke causing clot was now found, but I was deteriorating. My chance of survival at this point was not good.

By now, my boyfriend and our families had gathered at the hospital. The radiologist came out of the angiogram to give them the bad news. My blood evident on his scrubs, he gently told my family that they found a clot causing me to stroke, but the chances of my survival were not good. The hospital had recently initiated an experimental procedure for treating stroke. However, I did not meet that protocol.

The experimental stroke treatment was to inject Urokinase, a clot busting medicine, through a small catheter directly onto the clot slowly dissolving it. Unfortunately, the experimental protocol needed to be initiated within three hours of the onset of symptoms. It had been over twenty hours since the chiropractor had dissected my vertebral artery. After speaking with a researcher at a different location very familiar with the protocol, my interventional radiologist determined he had nothing to lose by attempting to bust the clot. They might as well give the new stroke protocol a try; I was going to die anyway.

The procedure that my interventional radiologist undertook that day to save my life was nothing short of a miracle. In 1992, from what I was told, I was only the third person to receive this life-saving experimental procedure. Not only did they perform my procedure outside of proper protocol by initiating the clot busting medicine almost 24 hours past the onset of symptoms, but they delivered the Urokinase directly to the clot for an hour longer than recommended to fully dissolve the clot. Typically, overuse of the clot busting agent will cause the patient to bleed out. I survived. Today, this procedure is considered the standard of care for treating stroke. Now, tPA is used instead of Urokinase as the clot busting agent. To learn more about the procedure, see the Society of Interventional Radiology website for full details.

To read about my recovery from this stroke, be sure to read

Vertebrobasilar Stroke Caused by Chiropractic Manipulation: The Recovery

It is important that you know the warning signs of stroke! Even with the new stroke treatment available, you must be treated within three hours of the onset of symptoms. If you experience any of the following warning signs, even if they go away, seek immediate medical attention. Call 9-1-1!

1. Sudden, severe headache with no known cause

2. Sudden trouble walking, dizziness, loss of balance or coordination

3. Sudden trouble seeing in one or both eyes

4. Sudden confusion, trouble speaking or understanding

Sources:

Personal Experience

Society of Interventional Radiology

American Stoke Association symptoms list

Vertebrobasilar Stroke Caused by Chiropractic Manipulation: The Symptoms

Vertebrobasilar Stroke Caused by Chiropractic Manipulation: The Recovery