Vertebrobasilar arterial insufficiency is a rare clinical occurrence in chiropractic practice. In order to better understand the clinical presentation of vertebrobasilar arterial insufficiency, 52 cases from the literature were reviewed with respect to the presenting symptoms so as to identify the relative frequency of their occurrence.1-33
Vertebrobasilar Infarct Symptoms (Based on 52 cited patients) | |
| Number | Symptoms |
| 32 | Dizziness and vertigo |
| 25 | Nausea |
| 20 | Vomiting |
| 19 | Inability to stand |
| 17 | Blurred vision |
| 13 | Loss of lower extremity control |
| 12 | Loss of consciousness |
| 12 | Facial numbness or paresthesia |
| 12 | Body/arm/leg numbness or paresthesia |
| 10 | Loss of upper extremity control |
| 9 | Headache (Predominantly occipital) |
| 9 | Dysarthria |
| 8 | Diplopia |
| 8 | Gait abnormalities |
| 5 | Dysphagia |
| 4 | Facial palsy |
| 3 | Tongue symptoms |
| 3 | Hoarseness |
| 2 | Tinnitus |
| Note: In this review, complaints of "lightheadedness" were included with complaints of dizziness and vertigo. | |
Chiropractic cervical manipulation was identified as the etiology for 21 reported cases of the 52 cases cited. There were 9 cases in which cervical manipulation was administered but the type of practitioner treating the patient was not identified. Osteopathic manipulation was implicated in three cases and spinal manipulations performed by medical doctors were identified as the etiology in two cases. One reported case involving a medical doctor was caused by a stroke during usual and customary cervical range of motion testing following a skiing accident. One reported case involved a physical therapist administering a cervical manipulation. Two reported cases were due to yoga exercises and another was related to self-administered cervical adjustments. Two cases clearly indicated head rotation while "looking over the shoulder" as the causative etiology for the vertebrobasilar arterial attack. The remainder of the cited cases occurred without manipulative intervention.
It must also be noted that in every case in which a loss of consciousness accompanied vertebrobasilar arterial insufficiency, dire consequences ranging from persistent neurological deficits to coma and death were the result. Therefore, one must consider loss or alteration in the level of consciousness following manipulation as an emergency situation requiring immediate medical attention. Terrett and Kleynhans examined 126 vascular accidents cited in the literature which occurred over a 55 year period.34 Their review revealed that only 29 cases of death following manipulation were identified world-wide in this 55 year period. When one considers the number of spinal manipulations administered each year, the risk for complications from this procedure is astronomically low.
References
When I graduated from chiropractic college in 1981 and started practice, I heard it all, and very little was positive. “You are a quack; you do not know what a subluxation is; you couldn’t get into a real health care program, so you chose the one that is slightly above a mail-order degree; you have no proof that chiropractic works; Are you really licensed?”, and so much more.
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