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199 thoughts on “Not to worry! Chiropractic Board says stroke not a risk of cervical manipulation.

  1. BillyJoe says:

    …..here’s the last two minutes of that video:

    http://www.youtube.com/watch?v=bpSF4EQ18Ns

  2. Scott says:

    Translation of Doc’s last post:

    “You’re wrong because I say so. I can’t provide any actual reasons you’re wrong, but I say so, so it’s true. Here, listen to me whine and make empty threats, because that’s all I have to offer.”

  3. nwtk2007 says:

    I find it amazing how the anti-chiro bias can blind the SBM group to such a degree such that they ignor their own “belief” in the precepts of science based thinking.

    The evidence either way is scant at best. The mechanism, as purported here is, if anything, iffy.

    There are so many things that can occur to cause blood clot formation in the vertebral arteries which could easily be the actual cause of these strokes. I find it interesting that it is believed that a clot can form but not become dislodged for hours to days and even weeks. If true, then any stroke could be attributed to just aboput anything. Bias here, selects CMT as the cause.

    Neurologists and MD’s in the ER have a habit of the same type of bias. Upon finding out if any stroke victim has seen a chiro with in the past month or two, will automatically attribute the cause to CMT. This is a broad statement but is, in fact, what has occured where the neurologist and ER doc has attributed a stroke to CMT. To be perfectly honest, they haven’t a clue and are simply guided by bias.

    As for proof of cause, the burden is on the accusers. Fact is, in real truth, they haven’t even proven a significant correlation outside of tid bits of “studies” which simply would not pass the SBM standards of significance with out their anti-chiro bias.

    Chiro’s cannot go out and find data to prove a lack of correlation except to say, where are the cases, which you now say rarely make it into the public arena. This is simply untrue. If the strokes are said to be caused by CMT, then the data is out there and it would have been publisised to some degree. If all you can offer is that the cases are not brought to the public eye, then you have nothing to base your “belief” on.

    I would point out that the first step in ridding ones self of a bias is to admit that you have one.

  4. marcus welby says:

    NWTK2007: most strokes due to chiropractic neck cracking occur within 24 hours, many occur on the treatment table with immediate seizures and in some cases eventuating in death either immediately or within hours. Fortunately about half of these VAD strokes recover in time nearly completely. Some result in profound neurologic deficit. Some result in first symptoms while the patient is driving home after the neck cracking or within a few days but up to a month or two later. All have demostrable vertebral artery or less commonly carotid artery damage in the neck and the usual site is the vertebral artery dissection between C-2 and the skull, just where knowledge of the anatomy would predict it would occur from any viewing of what chiropractors and some MDs (especially in Germany and elsewhere in Europe) do, which is obviously dangerous. The burden should be not on accusers, but in such an instance when no valid benefit of this obviously documented occasionally dangerous procedure has been shown, the burden is on those who insist on continuing to perform such to act to protect the public and cease.

  5. nwtk2007 says:

    Dr Welby,

    You are making statements previously made by members here which have been proven to be incorrect or flat out ficticious.

    You might have heard this misinformation elsewhere, but there is little truth to it.

    There are several very lengthy articles and discussions you can look at on this web site and see the same false claims made and debunked, so to speak.

  6. nwtk2007 says:

    Additionally, there is documented evidence of the benefit of CMT that has been presented here, but in almost all cases, summarily dismissed without so much as a discussion or analysis; in many cases criticised by some who later admitted that they didn’t even read it. Thus it is a waste of time to present the evidence for the benefits of CMT and also a waste of breath to say there are none.

  7. weing says:

    nwtk,

    What are you on about? You are unwilling to accept that what you do carries risk and refuse to even to gather data to see if it does and how much of a risk if it does. That is supposed to be the science based approach? Another point, I thought the strokes were caused by dissection of the vertebral artery and not by clot formation as you are purporting. Now I gotta go back to converting paper to electronic charts.

  8. nwtk2007 says:

    weing, I don’t know if you remember all the discussion over the past two to three years on this blog, but to suffice briefly, even Dr Hall has admitted that the evidence for CMT causing stroke amounts to little more than a “smoking gun”, as she and a few others have put it.

    I am now saying that in light of the lack of new cases of stroke being allegedly associated with CMT, this “smoking gun” is, at the very least, highly over rated.

    As to stoke and VAD, they are indeed, two different things, but ultimately, stroke is caused by blockage of a blood vessel to some portion of the brain, usually a blood clot. If the VAD results in a clot that becomes dislodged, then a stroke would be the end result. If the VAD results in rupture and bleed out then the result is a bit different but ultimately the same, deminishment of blood flow to some part of the brain.

  9. weing says:

    If the VAD causes occlusion of the lumen of the vessel, a stroke can result. No clot dislodges or even forms intraluminally.

  10. Harriet Hall says:

    When I brought up the “smoking gun” cases I didn’t mean that was the only evidence we had. Even the Cassidy study showed a correlation in patients under the age of 45, confirming earlier data. And there is a plausible mechanism because of the unique kink in the vertebral artery at the level of manipulation and the awkward way the artery is stretched at the extremes of rotation. The evidence is convincing except to those who make their living doing this dangerous procedure, often for totally bogus indications.

    Systematic reviews have shown no advantage of neck manipulation over gentle mobilization, and little evidence of efficacy. The reports chiropractors cite to support their beliefs are less convincing than the reports of stroke following manipulation. We apply the same standard of evidence to any claims.

  11. nwtk2007 says:

    Either way, the end result would be the same. It was your buddy, Marcus Welby, in a previous statement who first mentioned the idea of a blood clot forming on a damaged vessel and later mobilizing as an embolus.

    For you to say that no clot forms or dislodges is a bit presumptuous I think, but as I said, the end result would be the same.

    Also, if the damage is done and the stroke can occur weeks or months afterwards, then there is absolutely no way to pin point the cause to CMT. There are just too many possible mechanisms by which the same type of damage could occurr.

    In the study which seemed to indicate that the stroke incidence is more likely in the lower age group, one would have to at least consider the possibility that the younger age group is involved in activities which might lend themselves to being other likely causes of the damage to the artery; sports, etc.

    Once again, there is just no evidence, what so ever, of any connection of CMT to stroke. Simply none.

  12. marcus welby says:

    nwtk2007: It seems hopeless getting you to admit what we have observed, that chiropractic neck manipulation is too dangerous to perform ever. I have discussed episodes of stroke with victims in wheelchairs, and talked with the survivors after the death of victims of neck manipulation. I personally have discussed this occurrence with a number of ER physicians who were on site when confronted with victims, with neurologists and neurosurgeons with likewise experience, seen VAD arteriograms with the dissection exactly where one would anticipate injury from neck manipulation, and read multiple accounts in the U.S, Canadian, and european medical literature. Some neurologists have told me of victims with permanent neurologic damage caused by chiropractic family members. Some chiropractic textbooks I have perused council against neck manipulation stating the risk is not worth it. See for instance Chiropractic Technique by Peterson and
    Bergman, 2nd Edition, page 119, “Although this condition is extremely rare, chiropractic doctors should give serious consideration to receiving informed consent before applying cervical manipulation.” Same text Chapter 4 has references 110 and 111 by AGJ Terrett et al who evidently recommended that rotational manipulation of the upper cervical spine be abandoned in favor of lateral flexion adjustments. As to evidence-based data showing chiropractic neck manipulation is effective beyond the placebo effect, the Cochrane reviews and other recognized authorities are devoid of evidence to support your views.
    Since you seem unwilling to consider this evidence, I will not post further on this subject here.

  13. weing says:

    I found these articles that indicate there is an association. Unless you have data other than anecdotes, you are like the guy who talks about denying the existence of the alleged 1 in a hundred year flood over the past 40 years.

    Dziewas R, Konrad C, Drager B, et al. Cervical artery dissection–clinical features, risk factors, therapy and outcome in 126 patients. J Neurol. Oct 2003;250(10):1179-84. [Medline].

    Haldeman S, Kohlbeck FJ, McGregor M. Stroke, cerebral artery dissection, and cervical spine manipulation therapy. J Neurol. Aug 2002;249(8):1098-104. [Medline].

    Smith WS, Johnston SC, Skalabrin EJ, et al. Spinal manipulative therapy is an independent risk factor for vertebral artery dissection. Neurology. May 13 2003;60(9):1424-8. [Medline].

    Stevinson C, Honan W, Cooke B, Ernst E. Neurological complications of cervical spine manipulation. J R Soc Med. Mar 2001;94(3):107-10. [Medline].

    Norris JW, Beletsky V, Nadareishvili ZG. Sudden neck movement and cervical artery dissection. The Canadian Stroke Consortium. CMAJ. Jul 11 2000;163(1):38-40. [Medline].

    Rubinstein SM, Peerdeman SM, van Tulder MW, Riphagen I, Haldeman S. A systematic review of the risk factors for cervical artery dissection. Stroke. Jul 2005;36(7):1575-80. [Medline].

    Saeed AB, Shuaib A, Al-Sulaiti G, Emery D. Vertebral artery dissection: warning symptoms, clinical features and prognosis in 26 patients. Can J Neurol Sci. Nov 2000;27(4):292-6. [Medline].

  14. Scott says:

    As for proof of cause, the burden is on the accusers. Fact is, in real truth, they haven’t even proven a significant correlation outside of tid bits of “studies” which simply would not pass the SBM standards of significance with out their anti-chiro bias.

    No, actually, the burden of proof is on chiropractors to demonstrate the procedure safe and effective. It cannot be ethically offered otherwise.

  15. nwtk2007 says:

    Scott, we believe we have demonstrated the procedure safe and effective. The lack of any new ginuine or alleged cases is further evidence of that.

    weing, I have looked at the first of the papers you listed. It is just a re-iteration of the previous CMT/stroke studies we have previously discussed, listed as references. I do find it interesting that they mention other possible causes like, for example nose blowing and hiccups. Interesting don’t you think. If the stroke can occur up to months after the CMT, are you suggesting that the victim didn’t blow their nose or have the hiccups in all that time and that the stroke couldn’t have been related to that?

    The list of other possible causes is probably no where near complete either.

    Strike one on that list.

  16. weing says:

    nwtk,
    I made this new drug, turbocor. Works great for whatever ails you. No toxicities whatsoever. I haven’t tested it for toxicities because the burden of proof is on you to show that it is toxic.

  17. Scott says:

    Scott, we believe we have demonstrated the procedure safe and effective. The lack of any new ginuine or alleged cases is further evidence of that.

    The intellectual dishonesty on display here is mind-boggling.

    1. How many times has it been explained to you that your claimed lack is meaningless? Without you responding in any way?

    2. The “evidence” chiropractors have to demonstrate the procedure safe and effective is far, far, far, less than that demonstrating the risk. Yet you claim the former adequate the latter nonexistent.

  18. nwtk2007 says:

    You are both being obtuse.

    If it isn’t happening the it isn’t caused by CMT. You say you can’t find new cases and that I should somehow prove there aren’t any. Get real. I have searched and searched in all the ways I know of and there are none to be found. If you wish to dispute my finding of no new cases, ginuine or otherwise, then find them and prove me wrong.

    Does that help?

    Or, just accept the fact that there are no new cases as I have been unable to find any and leave it at that. If it isn’t happening then it isn’t happening, thus, since CMT is ongoing, probably to a much higher degree than ever, then there must be no connection.

    You say it isn’t tested? How would you propose it be tested? If a million or 10 million manipulations have occurred the past year and no new cases have occured, then I would say that is the test, so to speak. The cases shoudl be there, happening regularly, if there is, indeed, the connection that you claim.

  19. Scott says:

    For the 100,000,000,000th time. Just because cases are not reported does not mean they are not happening, because without systematic investigation and wide awareness they will not be reliably recognized.

    You have repeatedly refused to address any of the evidence presented that the risk is very real, instead continuing to parrot the same completely worthless, repeatedly destroyed claim.

    An identical argument:

    “John Smith fell to his death when his parachute failed to open. Ergo we know that parachuting can kill.”
    “No it can’t. Find me somebody whose parachute failed to open in the last month, or it proves that he must have died from some other cause.”

  20. Scott says:

    A few more details.

    You are both being obtuse.
    If it isn’t happening the it isn’t caused by CMT. You say you can’t find new cases and that I should somehow prove there aren’t any. Get real.

    If you wish to make the claim that it isn’t happening and use that as the basis of your argument, then YES you must prove that it isn’t happening! YOU’RE making the claim that it isn’t happening. YOU have to demonstrate said claim if you want it to show up.

    I have searched and searched in all the ways I know of and there are none to be found. If you wish to dispute my finding of no new cases, ginuine or otherwise, then find them and prove me wrong.

    Only a reasonable argument if there is a strong probability that you would have found any cases that happened. There is no reason to believe that, because such cases are not necessarily identified or reported.

    The rest of your post is completely predicated on the assumption that you’ve proven no cases have occurred, when in fact you’ve provided no credible evidence to that effect.

  21. nwtk2007 says:

    Scott, I have addressed most of what you have presented in past threads on this very blog. I’ll get back to the other “studies” presented earlier today. I have addressed one already.

    As to no new cases, if you are so smart and knowledgable, then find’em. I can find none. Your parachute analogy is weak at best. Its been a great deal of time. Shall I come back in another years, with still no new cases, and present the same argument?

    I understand that I havn’t proven there are no new cases. duh. But since there are none, and if you can’t find any, nor can I, then you must beging to feel at least a bit of a need to rethink your cmt/stroke connection.

    The fact that there was so much earlier on about it and thus some alleged cases, was due to the great publicity with the Nette case. Now that that has gone away, it just seems there is nothing new to be found, nothing new being reported and thus, maybe nothing happening.

    There is a medical data base and there are journals where case studies are published. Why arent there any new articles and case studies being reported?

  22. Harriet Hall says:

    nwtk2007 said “There is a medical data base”
    No there isn’t. There is no way to track these patients.

    “Why arent there any new articles and case studies being reported?”

    Perhaps because it isn’t news any more. Just because there are no new articles doesn’t mean it isn’t happening.

  23. marcus welby says:

    I have to break in again, with nwtk2007 still desperately attempting to defend the indefensible. In a hallway conversation this week with an anesthesiologist, he related his experience in a critical care unit on a 2 week rotation during residency recently in an Indianapolis hospital affiliated with IU. He saw 3 patients admitted with strokes due to chiropractic neck cracking. These occurrences are no longer news and no longer justify case reporting, which is weighted toward the unusual occurrence. Chiropractors think the incidence is low because they are unaware of the admissions to the hospital for strokes unless they personally are sued. They do not warn their patients of the risk and as repeatedly demonstrated, the ER team at the hospital may waste valuable time while the patient is unconscious trying to figure out the cause of the serious neurologic catastrophe, instead of proceeding to vascular imaging and anticoagulation therapy.

  24. nwtk2007 says:

    He said, she said. What a bunch of bull.

    If I related every story I “heard” from a doctor, then I could say, without a doubt, that all of those 500 deaths per day due to medical mistakes and errors are just coincidental and have nothing to do with incompetence.

  25. Scott says:

    So people provide the cases you’ve been demanding and you ignore them. Nice.

    And since I somehow missed your prior post:

    I have addressed most of what you have presented in past threads on this very blog. I’ll get back to the other “studies” presented earlier today. I have addressed one already.

    This has no relationship whatsoever to anything posted in the thread…

    As to no new cases, if you are so smart and knowledgable, then find’em. I can find none. Your parachute analogy is weak at best. Its been a great deal of time. Shall I come back in another years, with still no new cases, and present the same argument?

    Try to pay attention this time. If you wish to use as the basis of your argument that there are no new cases, then you must provide evidence establishing to a reasonable degree of confidence that there ARE no new cases. Simply saying it doesn’t make it so when it’s be repeatedly explained why the methods you’ve mentioned using are unreliable, and you have declined to address the points raised.

    I understand that I havn’t proven there are no new cases. duh. But since there are none, and if you can’t find any, nor can I, then you must beging to feel at least a bit of a need to rethink your cmt/stroke connection.

    No, not in the least. New evidence causes a need to rethink; absence of evidence from an investigation that would be EXPECTED to provide no evidence does not.

  26. nwtk2007 says:

    Scott – “So people provide the cases you’ve been demanding and you ignore them. Nice.”

    Sir, there is absolutely nothing new presented in this thread that has not been presented and addressed earlier in other threads.

    All of the studies presented simply cite earlier references and, in fact, point out other possible causes.

    I truly love the idea that I should be able to prove that something hasn’t happened recently when, if you are so sure, you could simply present the new cases and for at least a moment, give us something relevant to look at.

    As to prior posts, they are readily available on this web site.

    At any rate, there is currently no evidence that any new strokes have occured in the past year or two due to CMT other than a bunch of he said, she said stories.

  27. Scott says:

    If you’re genuinely THAT ignorant and determined to avoid all facts, then I guess I’m done here.

  28. Dr Benway says:

    I think the pro-chiro crowd here may have been misinformed regarding evidential standards.

    Yes, “standards” with an “s.” There’s more than just one.

    The standard for “claim x is worthy of study,” is much lower than the standard for, “claim x has been proven.”

    Analogy: the evidence needed for getting a search warrant is much less than that needed for a conviction. The former requires only probable cause while the latter requires “beyond a reasonable doubt.”

    Young people shouldn’t have strokes within 24 hours of a neck manipulation. One case alone is sufficient “probable cause” for further study.

  29. nwtk2007 says:

    Dr Benway, I think the pro-chiro crowd here can appreciate the “standards” of evidence much more than is admitted by the anti-chrio crowd here. The anti-chiro crowd has presented many, many more anecdotal “stories” than has the pro-chiro crowd.

    As to your suggestion that a person shouldn’t have a stroke within 24 hours of a neck manipulation, I would just suggest that in every single case of stroke within any time period after CMT, there is no evidence of any inquiry, what so ever, of other possible causes. The anti-chiro bias of those reporting these stokes “caused” by CMT prevents them from doing adequate history. There is no evidence of inquiry into the activities of the stroke victim 2 to 3 weeks prior to the stroke which could possibly be the actual culprit.

    Do you think the person reporting the cause as being CMT actually asked the victim if they had, within the past several weeks, participated in any contact sports, participated in yoga, been in an MVA, even one where there was actually no property damage or apparent injury, had any type of fall, been startled to such a degree that they might have turned their head suddenly, had a bad case of the hiccups, sneezed forcefully, etc, etc?

    The sheer number of other possible causes boggles the mind, it truly does. What do these medical professionals attribute the cause of stroke to in the absence of any history of chiropractic care?

    My point is that the evidence for CMT being the actual cause of these alleged cases of CMT induced stroke is nebulus at best. My guess is that there are, indeed, ongoing studies into this on both sides of the fence. My guess is that over the past few years there has just been so little true evidence to support the idea of CMT induced stroke, that we may never hear about these studies. Note, I said “may” never hear about them.

    Also, to suggest that new cases are not being reported because it is not “news worthy” anymore, is patently absurd. I doubt that the emotion of the Nette case has been lost, not the determination of the ones who believe they have suffered at the hands of chiropractors. To put it simply, the “victims of CMT” have simply stopped coming forward, or there just aren’t any.

    The Nette case was stopped by the judge because of the complexity of the suit. Nothing has prevented her from continuing her case against the one doctor regarding her specific incident. She might actually be doing this but I haven’t heard of it. I see nothing to suggest that the “news worthiness” of these alleged cases has been lost. It could also be that they are finding there is no evidence to support their cases.

  30. Blue Wode says:

    nwtk2007 wrote: “The Nette case was stopped by the judge because of the complexity of the suit. Nothing has prevented her from continuing her case against the one doctor regarding her specific incident. She might actually be doing this but I haven’t heard of it.”

    FYI, Sandra Nette’s malpractice suit against Gregory John Stiles is still active and is to proceed. See update (2) here:
    http://www.ebm-first.com/chiropractic/sandra-nette-v-stiles-et-al.html

  31. Jann Bellamy says:

    nwtk2007:

    “Do you think the person reporting the cause as being CMT actually asked the victim if they had, within the past several weeks, participated in any contact sports, participated in yoga, been in an MVA, even one where there was actually no property damage or apparent injury, had any type of fall, been startled to such a degree that they might have turned their head suddenly, had a bad case of the hiccups, sneezed forcefully, etc, etc?”

    You may not realize it, but you just admitted the plausibility of CMT causing stroke. Think about it.

  32. nwtk2007 says:

    Good. I’m glad she is going forward with it. It is a good venue to put a lot of this to rest and especially to bring out the fact that there is little to no evidence that CMT causes strokes.

    Jann, I never denied the plausability. Also, anything is possible, but some things are not probable.

  33. Dr Benway says:

    Ok let’s imagine some woman in her 20s gets a basilar artery stroke a few hours after a chiropractor cracks her neck.

    Her doctor asks about other risk factors over the past several days, and yes, she did have hiccups two days ago. She did hear a loud noise that startled her one day ago. She also fell down while playing soccer one day ago. And she sneezed one hour before the stroke.

    So that all means… what? The neck cracking is off the hook? No need to worry about it as a risk factor?

  34. nwtk2007 says:

    Same girl, same situation except the stroke occurs a few hours after going to her PCP for the same reason the other one went to the chiro. The doctor asks the same questions. She is of that younger group who is more active in all arena’s simply because she is young. (I refer here to a previously discussed study.)

    Is CMT off the hook? In this case yes.

    What it means Dr Benway is that in both cases, the cause of the stroke is unknown.

  35. pmoran says:

    ntwk: “Do you think the person reporting the cause as being CMT actually asked the victim if they had, within the past several weeks, participated in any contact sports, participated in yoga, been in an MVA, even one where there was actually no property damage or apparent injury, had any type of fall, been startled to such a degree that they might have turned their head suddenly, had a bad case of the hiccups, sneezed forcefully, etc, etc?”

    Is it now your argument that all these things can cause stroke, but neck manipulation, a potentially much more stressful event, can’t? Or are you admitting that it (also) can, as temporal and statistical associations peculiar to CMT indeed suggest?

  36. pmoran says:

    nwtk, I also totally reject your frequent accusations of undue bias.

    We doctors would be remiss by our own most minimal standards if we were not pushing for all those using CMT (not only DCs) to react to this risk, or the strong potential for risk if you prefer.

    Given the practical hurdles in trying to ban neck manipulation altogether and the possibility that there may be a small subgroup of patients who may benefit from it, I personally would be quite happy if chiropractors and others using it showed some signs of setting reasonable evidence-based guidelines as to how and when it was performed, along with an average standard of informed consent.

    It is the apparent utter rejection by some chiropractors of the need for — well, anything — that is provoking more violent reactions. We can see strong financial biases behind that.

  37. Dr Benway says:

    nwtk2007, what if we knew the incidence of basilar artery stroke in all persons under, say, 40 years of age.

    Wouldn’t we learn something, if we did a prospective study of all persons under 40 getting their neck cracked over the next year, monitoring for any basilar artery vascular events?

  38. BillyJoe says:

    By looking for harmful effects, it has been found that Amaryl used in the treatment of diabetes increases the risk of heart attack by 43% (I prefer absolute risk, but that’s not important here).

    No one would have made the link if they didn’t specifically look for it. It now seems that the manufacturers tried to hide this fact, which is only slightly worse than not looking for adverse effects in the first place.

  39. weing says:

    “By looking for harmful effects, it has been found that Amaryl used in the treatment of diabetes increases the risk of heart attack by 43% (I prefer absolute risk, but that’s not important here).”

    Do you have a reference for that? I was aware that the sulfonylurea drugs, like glipizide and glyburide, more or less double the risk, but not about glimepiride.

  40. Doc says:

    nwtk2007, the anti-chiro crowd here think like homeopaths when it comes to CMT of the neck and stroke.

    It’s that CMT of the neck and not all those other things you mentioned that the neck does daily which caused the stroke to occur later even though CMT of the neck is so bio-mechanically “diluted” compared to all those other things the neck does daily that not even a molecules (worth of force) can found. The blood vessels have a mystical memory of CMT imparted on them.

    At least that’s what I think James Randi would have said about this SBM crowd ;-).

  41. Dr Benway says:

    So CMT of the neck is like, not moving your neck very much?

    I thought you guys were crackin’ necks.

  42. Joe says:

    @Dr Benway on 18 Jul 2010 at 9:14 pm wrote “So CMT of the neck is like, not moving your neck very much?”

    In some cases, yes. There are no standards in chiro. Dr. Hall found one case of a chiro in Washington state who did not even touch her customers when she “adjusted” their necks. Others use mechanical, tapping devices that do essentially nothing. Some use gentle mobilization such as is sometimes recommended by health professionals.

    On the other hand, you can find videos on YouTube which are painful to watch.

  43. mrbasher says:

    I am here looking for any help I can get, I don’t even know what I need, please read… I am writing this on behalf of my girlfriend.

    On July 11th of this year my girlfriend had a stroke and was rushed to the emergency room because of it. They had no idea what had happened other than “her neck ‘popped’ while drying her hair” at which point she immediately became dizzy, numb on one side, etc. etc. I’ll save the details, but after two CT scans and a MRI they determined that she had suffered a stroke. The stroke was caused by a clot that had formed due to vertebral artery dissection. She was then immediately taken to a stroke center for treatment. Luckily they were very quick about all of this or she would be much worse off than she is now.

    She spent 5 days recovering in neuro-intensive care and just began rehabilitation this past Saturday. She is doing better and better every day. At this point she has double vision, trouble swallowing anything that is even close to water thickness, and must regain functionality of her right leg, among other things.

    The reason why I am posting here is this: She visited the Chiropractor only days before this happened. After leaving she complained of neck pain. She woke up with a horrible headache the morning of the event. Upon reading her notes/chart (not sure what they call it) each doctor has made clear what they believe was the the cause of this… Care to guess what they have unanimously said? I think you know where I’m going here.

    At this point the prognosis is that she will make a full recovery. However, no one can be certain of the event’s long term impact on her life. As well, NO ONE should have to go through this, ever… She was NOT made aware of the risks.

    Lastly, she is 30 years old!!! :(

    Please help… Thank you.

  44. marcus welby says:

    Mrbasher: fortunately, about half of VAD stroke victims recover nearly fully with anticoagulant treatment and time. Sounds like she is getting good care.

  45. mrbasher says:

    Thank you for your responses…

    Just a little more info, although I will not disclose the name of the hospital or doctors here…

    When asked whether or not she was in danger of having another stroke, one neurologist stated that her stroke was caused by physical trauma and not issues with her general health. Because of this, baring a change in health, she should not be at risk of another stroke after anticoagulant treatment.

    The “lead” doctor (not sure what they are called) which was doing rounds with a large group of other doctors came by the first morning we were there and upon hearing the that she had been to the chiropractor only days earlier stated very matter-of-factly that it wasn’t surprising. As they left, I asked the doctor what he meant and he stated that we were in a “stroke center” and that if you have a stroke and you live anywhere near here, this is where you’d come. He went on to say that while going to the chiropractor does not mean you will end up with a stroke, the vast majority of young people that come in had just seen the chiropractor and had not had any other physical trauma.

    Thanks for listening.

  46. mrbasher says:

    nwtk2007,

    You’re repeatedly asked for examples… Wish granted.

    Thanks

  47. nwtk2007 says:

    You’ll have to forgive me for not believing a word you say and that I strongly suspect that you are a certain blogger who goes by many aliases and is well known for such fiction.

    I’ll have to admit that the “not knowing what the “lead” doctor is called” is a nice touch over your previous posts on the other blogs.

    Get real.

  48. mrbasher says:

    I can understand how you might have run into someone doing what you describe… Especially if you often get into these types of debates on other blogs. However, I assure you that I am not this other person you speak of.

    I came across this site while doing research into whether or not the stroke could have actually been caused by her chiropractor. I did not believe it myself, especially given their apparent certainty. As well, I had never ever heard of something like this happening, so I decided to do some looking on my own.

    Be callus if you wish, maybe you do not intend to be… But rest assured, as much as I wish it had not, this DID just happen… For whatever reason all signs point to chiropractic manipulation as the source. I’m not a doctor of anything, just a computer guy that wants his girlfriend to be happy again and live a normal life. So you’ll have to forgive me if I don’t know what the “lead” doctor is called.

    This is the most “real” thing that has even happened in my life… I can’t imagine it being any more so. You’re true colors have apparently come out in full force here… Are all of your statements based purely on assumption and past experience?

    Lastly, I don’t care if you think it’s true or not… I came here asking for help. I did not even realize you had asked for examples until I went back and read through all of the comments… After reading your posts, I found myself wishing I could edit my first post to say “Here’s an example” but I could not. You assumed the worst, something it sounds most chiropractors should as well.

  49. JMB says:

    @mrbasher
    We hope your girfriend will have a complete and rapid recovery.

    @nwtk2007
    Just a lesson in SBM. If mrbasher was dishonest, what harm has that done to you? If mrbasher is honest, what harm have your attacks done to him. Perhaps your profession does not take the Hippocratic oath? SBM is about more than randomized clinical trials and relative risk estimates.

  50. Joe says:

    @mrbasher, Another good source of information for you is http://www.ebm-first.com/chiropractic/risks.html Particularly note the most recent review of chiropractic harm under the title “Deaths after chiropractic: a review of published cases.”

  51. nwtk2007 says:

    JMB,

    If mrbasher is dishonest then he is attempting to harm the profession and using the tactics of so many anti-chiro individuals, that the ends justify the means. It has been done countless times by the anti-chiro trolls on many blogs. I place it right up there with commenting on research without even reading it.

    If honest then he shouldn’t be hurt in the least. He came here with an agenda for much more than “help” for his “girlfriend”. That much is obvious. On its face value, this is nothing but a story, possibly contrived, representing bait for those of us who continue to see very clearly that there is little, if any, evidence that CMT causes strokes.

    As to this fictional account, what is this “pop” that the girlfriend heard while drying her hair? It must have been quite a “pop” to be heard above the noise of a hair dryer. The fictional fact that she had been seen by a chiro recently can, in no form or fashion, be linked to that. It is claimed that she left the chiro complaining of neck pain. Was that the reason she went to see the chiro? What is the history of her neck pain beyond what has been provided here?

    There is much to ask about this fictional account. Why not bring it up to the level of something real. Mrbasher is in no danger of violating HIPPA and, I would suspect that if the MD’s truly felt that the stroke was caused by CMT that they would take steps to bring this out in some form or fashion.

    I’ll stand by my suspicion that this is fictional until proven otherwise.

  52. mrbasher says:

    @nwtk2007

    Again, you assume far too much…

    I did not come here looking for a fight or to “stoke the fire.” As well, I did not even realize this was some type of anti-chiro blog… Must I continue to reiterate that I was and still am, in the process of doing research on this whole thing? You’re not helping “your side” either…

    You “sir” are the one attempting to stoke the fire by doubting the reality of this situation and attempting to discredit someone who has done nothing more than ask for help. Why it is so difficult for you to believe this has happened is beyond me… However, I do not find it necessary to “prove” anything to you or anyone else here.

    If you had taken this opportunity to actually help me in this situation by providing whatever knowledge you may have on the subject, I would have appreciated your input. Instead you have simply dismissed the possibility that this even happened. Again, doing “your side” no favors. Please forgive me for starting to actually “take a side” in all of this based partially on your input here.

    You’re asking me to prove something over the internet which is a ridiculous request, especially since this JUST happened. As well, I’m not providing anyone with any specific information at this point because I don’t know what the implications of doing that might be and certainly not to someone like yourself.

    I will, for whatever reason answer your questions:

    She went to the chiro for neck/upper back pain, as she had previously on occasion. Nothing too horrible really, just your typical pain from sitting in front of a computer screen all day. However, this time her neck hurt after leaving and upon calling to ask the chiro about it was told to make another appointment, which she did. I must point out that the pain she was feeling after he last visit was in the exact same location as the VAD. He stroke happened prior to her scheduled visit.

    The “pop” as she describes it very well may not have been heard but felt/perceived… I don’t know for certain. I never stated that she was using a hair dryer at the time and I haven’t asked her that. All she has said thus far is that she bumped that part of her neck with her hand and heard a pop, followed by the stroke. (and no, I doubt she karate chopped herself in the neck hard enough to cause a stroke) I do not think she heard a literal popping sound but a clot going into your brain stem might very likely cause any number of strange sensations, including a pop sound/feeling.

    Lastly nwtk2007, I urge you to go back and reread my posts… I have not at any point attempted to discredit chiropractors. I told of our situation in the process of asking for help and only after your responses have I eluded to my increasing distrust in the profession. YOU are making my posts into something they were not intended to be and I can only guess as to why. Frankly I am amazed and I feel you should be ashamed.

    To those that have tried to help, thank you. I’m not going to debate any of this with anyone here because admittedly I don’t know what I’m talking about outside of my current situation. Thanks again.

  53. nwtk2007 says:

    mrbasher,

    you are now becoming inconsistent in your information. Firstly, you did not mention a hair dryer but you did sat that she heard the “pop” while drying her hair. I guess she might have been towel drying it, as girls do, forcefully turning their head to one side, draping the hair over the shoulder and squeezing the hair with a towel. I have two daughters and have watched this activity in them and a few girl friends as well over the years. It is a bit violent. One even used the air from the outside A/C unit, running a brush thru her hair and flipping her head in all manner of ways. If this had been going on for years, how could you possibly not see that this might be the very thing that might have gradually, over years and years, caused the damage that lead to the stroke in the first place.

    Anyway, secondly, you say that the pop could be the sound of a blood clot going into the brain stem. I guess you’ve brushed up on your anatomy a bit since not even knowing what the “lead” doctor might be called. Just a computer guy?

    As to your intent in the first post, you end it with:

    “Upon reading her notes/chart (not sure what they call it) each doctor has made clear what they believe was the the cause of this… Care to guess what they have unanimously said? I think you know where I’m going here.”

    Certainly the intent is clear here as to what it is you are implying. This statement is, if anything, an indirect accusation of a sort. I also find it a bit unbelievable that you would have spoken to each doctor that has “read her note/chart”. You are not a relative and thus the doctors would have had to have had a signed release from your “girlfriend” for them to even address her case with you. HIPPA laws are very particular about protecting the health information of the patient. And doctors are very leary of discussing this health information in the presence of anyone not clearly designated to be allowed in on such discussions.

    Lastly, you say you are looking for help. What sort of help in particular?

    I find that the more you post here, the more unbelievable your story becomes.

  54. mrbasher says:

    I don’t really see how I am becoming inconsistent… You seem to be arguing the semantics of how I’ve relayed the apparent “pop.” I don’t know if it was heard, felt, imagined, etc. It doesn’t matter and I fail to see why you are concentrating on that.

    You are correct, I did end with that statement… I will admit, I did read the article before posting and wrote that paragraph based upon my perceived correlation between it and the events she experienced. However, while I did not perceive the article as bashing the profession, I felt it safe to assume people could guess based upon the contents of the article. Poor choice of words on my part I suppose.

    As for my knowledge regarding all of this, while I may not be a medical professional, I am certainly capable of simple tasks such as reading and listening. I spent 5 days by her side in intensive care… If it were someone you loved, don’t you think you’d absorb as much of what was said as possible? Ask as many questions as possible? Do research so you can understand what’s happening? If I’d ever heard someone say what the main doctor that was doing rounds was called I’d have called them that here, but I didn’t hear that. In fact if I knew, you’d just use that against me anyhow so whatever.

    I don’t know how HIPPA works or even what it is apart from what you have stated here. However, I spoke to every doctor that visited her directly and was always in her presence when doing so…

    The help I am looking for is simply more information in order to determine whether or not this could have been caused by her chiropractor.

    I know of the hair flipping thing you speak of and have seen previous girlfriends doing that… I agree it seems a bit excessive. However, I have never seen my current girlfriend doing those things. I still haven’t said whether or not she was using a hairdryer or a towel at the time because I don’t know and will have to ask.

    I just don’t get why you are being like this, otherwise I’d stop responding. It doesn’t make any sense to me… You have no idea if it happened or not, it shouldn’t matter to you either way, and yet you have decided to continue doubting the fact that it actually happened. Not only that but you’re tearing apart each post searching for a way to discredit me. I don’t need to be discredited, I never had any credit to begin with and neither do you, given that we are posting on the internet. This is a terrible thing that has happened to her whether the chiropractor caused it or not and I don’t really appreciate your assumption that it didn’t happen. You gain nothing in doing what you are other than the reputation for being jerk. How can you not see that? You apparently don’t believe in Karma.

  55. mrbasher says:

    One more thing… Sorry for the double post…

    If you want to refute the possibility that it was caused by her chiropractor, I have no problem with that. However, that is not what you are doing. You are denying entirely, based solely on you’re “gut” that it even happened.

  56. nwtk2007 says:

    I’ve given you good reasons to consider as more likely cause than any chiro treatment, based upon what little info you have given.

    For example, if the hair drying caused a pop, and she has been doing this for years now, isn’t it more likely that the damage which led to the stroke had accumulated over those years and was, in fact, finally caused by the hair drying, and not the chiropractic treatment? It could even have been damage from this activity, the hair drying, that caused the symptoms for which she initially went to the chiro for in the first place.

  57. Joe says:

    @nwtk2007 on 23 Jul 2010 at 5:12 pm wrote “I’ve given you good reasons to consider as more likely cause than any chiro treatment, based upon what little info you have given.

    You have been given a lot of information about chiros causing strokes and you either cannot understand or do not want to. Either way, it does not bode well for you.

    On the other hand, mrbasher has expert opinion of real doctors at a stroke center.

    I’ll leave it as an intellectual exercise for you to choose, and explain, whom he should believe.

  58. JMB says:

    nwtk’s thesis of accumulated damage in a blood vessel of someone who is 30 from hair drying doesn’t jive with current medical knowledge. Accumulated damage due to mechanical trauma is seen in tendons, ligaments, and cartilage… all of which are relatively avascular. Blood vessels heal much more rapidly after damage. When mechanical damage to arteries occurs, we see it much more commonly in areas where vessels branch, in patients with lipid disorders, patients who smoke, and patients with prolonged hypertension. Accumulated damage to arteries is more commonly seen in the age group of 45+, even in those with risk factors.

    When mechanical forces are greater than encountered in everyday activities, there are certain areas that we tend to see arterial damage; the traumatic tears of arteries including dissections. The occurrence of dissection of arteries in the neck following motor vehicle accidents, and chiropractic manipulation is a clinical observation, even though it is uncommon. In both cases, the position of the neck and the force of distraction is considered a mechanism of injury. The vertebral artery extends upward through holes in the bone at each vertebral level. When the cervical vertebral are moved from the neutral position you assume when standing still, some parts of the two vertebral arteries in the neck may be stretched because the relative position of the holes in the bone change. Forceful distraction of the neck will also produce stretching of the vertebral artery. Stretching of an artery can result in tears of the layers of the artery. If the inner layer of the artery, the intima, is torn, dissections and blood clots can occur. Such damage in one of a pair of vertebral arteries can result in neck pain, but not a stroke if there is still adequate blood supply from the other vertebral artery. Now if the dissection (tear in the inner layer) extends up high enough into the brain, or if the blood clot breaks off and floats up to the brain, then arteries without good collateral blood flow may be occluded, and the stroke develops. Intimal dissections can extend, or blood clots may dislodge for several days after an injury. As time passes, the artery heals, the risk decreases. After a few months, it may be hard to tell where the vessel was injured.

    The vertebral arteries don’t branch until they are inside the skull, in an area affected very little by movement. The two vertebral arteries supply some of the vessels to the brain stem and cerebellum that do not have good collateral supply. Here is a link to the wikipedia article with some pictures of the anatomic points I have discussed. Hopefully, this will be helpful.

    http://en.wikipedia.org/wiki/Vertebral_artery

  59. marcus welby says:

    JMB’s post is explanatory. A little knowledge of the anatomy is useful here. From a biomechanical standpoint, it helps to know that in addition to the vertebral artery leaving the confines of the bone at C-2, then making sharp turns before ascending into the skull, HALF of the neck rotation (roughly 45 degrees of the 90 degrees to either side) occurs between C-1 and C-2 and that is the exact location of the demonstrated tear in the vertebral artery wall when the stroke is investigated by arteriography. Over and over, that is where the damage occurs. Rarely, carotid arteries are injured, but mostly it is this exact location in the vertebral arteries in young people with no prior risk factors and no demonstrated atherosclerotic plaques at time of the imaging study. Anyone who understands these anatomical facts who has watched a video of the high velocity neck manipulation favored by chiropractors, and some MDs in Germany can readily appreciate the risk. Having spoken with a number of victims or their surviving family members, many of the strokes begin immediately following the neck twisting while the patient is on the treatment table, but some occur in the car while driving home or later that night, even up to a month or more later. Chiropractors deny the risk out of either ignorance or a shortsighted sense of economic protection of the profession. No other explanations are understandable.

  60. nobs says:

    # mrbasheron 20 Jul 2010 at 4:57 pm
    “On July 11th of this year my girlfriend had a stroke……snip……Please help… Thank you.”

    mrbasher-
    A more likely cause, in this age group, would be this:

    ScienceDaily (Oct. 27, 2009) — She was only 30 years old, but she was experiencing the classic symptoms of a stroke. Her speech suddenly became slurred, and her left hand became clumsy while eating.

    What triggered her stroke, at such a young age, may have been the birth control pills she was taking. Oral contraceptives nearly double the risk of stroke, according to a review article in MedLink Neurology by three Loyola University Health System neurologists.

    http://www.sciencedaily.com/releases/2009/10/091026152820.htm

    Let me also direct you to a few other relative and important sources, that you you will find informative:

    http://smperle.blogspot.com/

    Science, Sometimes- Stroke and Chiropractic

    “snip……What is the epidemiology of these strokes? They are rare representing 2% of all ischemic strokes but 10 to 25 percent of strokes in the young and middle aged.(5) These facts are not well known so when someone in who is young or middle aged presents to a hospital with a stroke everyone wants to know why. Given the bias and bad information then the question comes, “did you see a chiropractor within the past month?” This only serves to expand the perceived value of this belief. It is not uncommon to hear someone say that the risk is proven. Proof is a word I tell my students that they can never use when referring to biomedical research. There is either evidence that supports or refutes a particular hypothesis. IF they want PROOF then their career choice should become mathematics not health care.

    Or that there is 80 years of science backing this up. Well time to go back to that earlier quote: “the pleural of anecdote is anecdotes not evidence.” There isn’t an 80 year history of science with respect to the association between cervical manipulation and stroke, there is an 80 year history of anecdotes that appears in the scientific literature. The real science behind this issue has a much shorter history. We get a survey of neurologists in 1995 (6) with a very poor response rate and which suffers from referral bias. (7) Plus a survey doesn’t establish cause and effect. There are many studies of cases that have tried to discover the incidence. For example this paper by Haldeman et al which estimated that one chiropractor in 48 would during the course of their practice career would be made aware of an arterial dissection following cervical manipulation. But none of these papers actually evaluated the risk.

    There are only three studies that have evaluated the risk of stroke after manipulation. And all three agree there is an association. (9- 11) The first two found a risk (9, 10) and the third (11) finding the same association provided evidence that explains the first two. Cassidy et al (11) used the same data sources as Rothwell et al (9) but Cassidy et al study investigated one thing neither Smith (9) nor Rothwell (10) did and that is they determined the background rate of these strokes. The issue is if the rate of strokes after chiropractic care was greater than the background rate (those that were occurring spontaneously not caused by the manipulation) then we would know what the added risk was due to manipulation. The finding, the rate of strokes in patients under 45 seeking care from their primary care physician was identical to the rate for those who had seen a chiropractor. Thus seeking chiropractic care produced no extra risk for stroke over and above the background rate. It appears that patients about to have a stroke from a dissection of a vertebral artery (the kind blamed on chiropractic for 80 years) seem to go to a doctor (a medical doctor or a chiropractic doctor) and the only reason the association between chiropractic and stroke appeared to be strong and not for PCPs is that no one asks the question in the emergency room, “did you see your MD within the past month?”"snip…”

    Here is a link to the Cassidy study:

    http://www.ncbi.nlm.nih.gov/pubmed/18204390?dopt=Citation

    Ask your girlfriend’s Docs if they have read/are familiar with this study.

  61. BillyJoe says:

    weing,

    BillyJoe: “By looking for harmful effects, it has been found that Amaryl used in the treatment of diabetes increases the risk of heart attack by 43% (I prefer absolute risk, but that’s not important here).”

    weing “Do you have a reference for that?”

    Sorry, I did that from memory.
    It was Avandia, not Amaryl:
    http://www.guardian.co.uk/commentisfree/2010/jul/17/ben-goldacre-diabetes-drug

  62. nwtk2007 says:

    JMB – “nwtk’s thesis of accumulated damage in a blood vessel of someone who is 30 from hair drying doesn’t jive with current medical knowledge”

    I’d like to know how you can conclude this. You need to acknowledge that these same types of strokes occur in an almost equal number of individuals who have not been cervically manipulated. The finding of slightly higher incidence in a younger population is easily understood from the basic knowledge that younger individuals are more active and more likely to be involved in activities which place stresses on the vertebral arteries.

    By the way, the vertebral arteries don’t branch but join to form one larger basilar artery which then branches to supply various parts of the lower brain and brain stem, with the exception of a small branch which supplies the upper spinal cord.

    JMB – “The occurrence of dissection of arteries in the neck following motor vehicle accidents, and chiropractic manipulation is a clinical observation, even though it is uncommon”

    The occurrance of strokes after a great many other events is also a medical observation, although not well investigated. The fact is that with the mention of chiropractic the cause automatically goes to the manipulation. It doesn’t even matter if the chiropractic care was months ago or related to a low back condition, it is still the automatic choice of cause. When there is not previous chiro activity, there is little, if any, investigation into other possible causes.

    And Joe, you know as well as I do that opinions are like anal orifi, most everyone has one. You have, in the past, admitted to having given opinions on studies that you haven’t read or it was painfully obvious that you had not read them.

  63. Y’know, I think that ntwk2007 doesn’t exist either. They are a straw-man figment of the imagination of someone who believes in ethical, evidence-based practice who has created the fictitious persona of ntwk2007 to make chiropractors look bad.

  64. Harriet Hall says:

    mrbasher,

    Don’t let the chiropractic apologists snow you. I covered the evidence for chiropractic and stroke at http://www.sciencebasedmedicine.org/?p=94
    Dr. Crislip eviscerated the Cassidy study at http://www.sciencebasedmedicine.org/?p=170
    Sam Homola (a chiropractor) also addressed this issue at http://www.sciencebasedmedicine.org/?p=1037

    The evidence that neck manipulation can cause stroke is strong enough to convince unbiased observers. The only ones who don’t accept the evidence are those who make their living manipulating necks. Since they don’t have good evidence or arguments on their side, they are reduced to despicable tactics like accusing you of lying.

  65. nwtk2007 says:

    I find it very un-SBM to be unwilling to admit that the true cause of mrbasher’s girlfriend’s stroke is more likely something other than CMT. The supposed fact that she heard a pop while drying her hair is a strong indicator that she has been putting stress on her neck repeatedly over years of this type of activity. As I said, it makes perfect sense and could very well be the initial cause for her to seek chiropractic care in the first place.

    This anecdote has so many holes in it as to be not even worthy of consideeration of even a smidgen of evidence that CMT causes strokes. It is only your bias that would prevent you yourself from pointing this out.

    And I’m not calling mrbasher a liar or saying that he is lying, I simple don’t believe a word of his story is true and not ficticious. He or you can take that in any way you wish. If it truly is a ficticious story, then he is a liar. Period. I simply say that I don’t believe it to be true.

    And Dr Hall, you yourself, in past threads have finally admitted that there is little or no evidence that CMT is a true cause of stroke. In your own words, what there is amounts to only a smoking gun, which I have pointed out, time and again, is not a smoking gun in an equal number of incidents, except for the younger group as has been previously pointed out, can be understood clearly in light of the greater activity levels of that younger group, doing the types of activities that could easily put more strain on the vertebral arteries than manipulation.

    It is the cumulative effects of these activites that hides their obvious role in this extremely rare event.

  66. Harriet Hall says:

    nwt2007 says “you yourself, in past threads have finally admitted that there is little or no evidence that CMT is a true cause of stroke.” That’s a lie, and it’s been alleged before and I’ve denied it before. You just chose to misinterpret my words. I am not relying just on the “smoking gun” cases, and I have made that abundantly clear. There is plenty of other evidence. I only brought up the “smoking gun” cases as something that chiropractors have not even attempted to explain away, because they can’t. There are cases of asymptomatic patients getting their neck manipulated, feeling a pop and immediately developing pain, dizziness and stroke symptoms while still on the table, and imaging shows a tear in the vertebral artery. Even most chiropractors admit that this can happen. Your denialism is becoming tedious. It’s tantamount to saying a post-op infection wasn’t caused by the surgery but was already present or would have developed anyway.

  67. Joe says:

    @nobs on 24 Jul 2010 at 8:15 am

    You offer a press release about an unpublished study as evidence for what I believe is already known. Tell me, do you think the strokes associated with birth control pills are due to artery dissection?

    You also offer the opinion of a chiropractor who selects the lit. he cites and is ignorant-enough to believe the Cassidy study.

    I’ll give you the same challenge I gave to the other chiro- when it comes to health, should mrbasher believe a chiropractor or the several health professionals (doctors, at a stroke center, no less) who said the chiro was likely responsible?

  68. mrbasher says:

    I tell you what… If we end up taking this to court, I believe it would then be public record. If that is the case, I will be sure to post the information here in hopes that maybe other people can at least have the opportunity to decide what is best for them, regardless of the perceived odds.

    I’m not going to argue any further whether it actually happened, it’s simply a waste of my time which can honestly be better spent.

    nwt2007, for your sake, given that your are a chiropractor I wish you and your patients the best of luck with neck manipulations. If drying ones hair as you describe is a more likely cause of vertebral artery dissection than neck manipulations, I wish your daughters the best of luck when doing so.

    It is completely outrageous to categorically deny the possibility of this being caused by neck manipulation. You could at the very LEAST admit to me and everyone else here that is is a possibility, despite it’s rarity. You have not done so and I simply cannot understand that. Forgive me, but it seems a bit ignorant. Yes, I have come to the conclusion that it was caused by her chiropractor, but I have not done so based purely on assumptions. I started researching this with absolutely no bias whatsoever… The same cannot be said for you. You need to get that chip off your shoulder and stop assuming that everyone speaking of chiropractic malpractice is taking a shot at you.

    Some number of posts ago, you told me to “get real.” You said this with absolutely no knowledge of who I was or whether or not I was telling the truth. Can you not even fathom how ridiculous that looks? How can you expect anyone here, even people in your own profession, to buy into that kind of blind disregard for another human beings apparent anguish. I will go so far as to say your posts are borderline “troll” and because of this I will simply ignore you from here on out, as should the rest of you. Go look in the mirror and ask yourself if you’d done the right thing here, if YOU’VE been “real.”

    Goodbye.

  69. Blue Wode says:

    It’s interesting to note that the legal profession is now beginning to take the chiropractic neck manipulation and stroke association very seriously. The following link, which has good, comprehensive, medical and legal information on the issue, is dedicated to chiropractic stroke victims:
    http://chiropracticstrokevictims.com/

    @ mrbasher

    I’m sorry to hear about your girlfriend and wish her a full and speedy recovery. It would probably be time well spent if you were to browse the above link.

  70. Jann Bellamy says:

    @mrbasher:

    I also wish your girlfriend the best of luck in her recovery.

    She has a right to her medical records, so she might want to get a copy. From your description, I imagine the records will show that her dissection was caused by chiropractic manipulation. If not, she might want to find out why that was not included in the diagnosis.

    I agree that the website referenced by BlueWode is an excellent place to start your search for an attorney.

  71. JMB says:

    @nwtk

    I suppose you claim to have studied anatomy with the same rigor as us biased doctors. Perhaps chiropractors deny the risk of vertebral/basilar infarctions because they all ignore the posterior inferior cerebellar artery like you do.

    http://en.wikipedia.org/wiki/Posterior_inferior_cerebellar_artery

    Please note the symptoms of occlusion of the PICA (the article has errors, but the main points are correct). You will have to follow the link for the symptoms.

    Once a vessel, or any other structure in the body, has been torn, it may take only a minor force to complete a tear. Ligaments, tendons, and cartilage heal very slowly, and often incompletely. Therefore, we see many patients in which simply turning while walking produced a big cartilage tear. Blood vessels heal much more rapidly, and usually completely in a 30 year old. That is the problem with the postulated accumulated injury from hair drying. However, a recent injury to the vessel could have put the patient in the precarious situation that common every day activities could have resulted in the stroke. If the injury had been recognized, and the patient anticoagulated, perhaps the stroke would not have occurred.

    Strokes have many causes. Only a minority are due to dissection (not all dissection result in stroke). An obvious problem with performing an observational study of all types of stroke, is that no conclusion can be reliably made about the less common varieties of stroke. If you were concluding that strokes could not occur due to decompression sickness, because the incidence of stroke was no different between people who got in the water versus people who saw their primary care physician, then you would obviously be wrong.

  72. nwtk2007 says:

    Interesting the delay in Nobs post. Good summary of the current research.

  73. Joe says:

    nwtk2007 on 25 Jul 2010 at 11:50 am wrote “Interesting the delay in Nobs post. Good summary of the current research.”

    How do you know there was a delay?

    So, the “good summary” comprises a press release about an unpublished study (as evidence for what I believe is already known). And the opinion of a chiropractor who selects the lit. he cites and is ignorant-enough to believe the Cassidy study.

  74. JMB says:

    @nwtk

    The fact that that article was published reflects poorly on the peer review process. Not all vertebrobasilar strokes result from dissection. Most strokes occurring from an arterial dissection will develop within a short time frame (typically less than a year, more commonly in the first week). Nearly all arterial dissections are symptomatic, so they should have considered only those patients who reported worsening of pain during the provider visit.

    If the author wanted to prove the lack of a causal relationship, then the correlation should have been made between a visit to the chiropractor or PCP within a week before the onset of the stroke, excluding any cases in which patients had visited both the chiropractor and PCP. Instead, the factor considered by the study is whether the patient had seen either provider within a year prior to diagnosis. Furthermore, the presence of a dissection of the vertebral artery causing the stroke should have been verified. Many would have been due to other causes. Since arterial dissections are rarely asymptomatic, they should have considered only those patients in which pain became significantly worse during the visit to the chiropractor or PCP.

    Using a more science based selection criteria, the results would likely have been different. The selection of a one year time frame is probably sufficient to obscure any causal relationship.

  75. mark says:

    I thought the usual guide for informed consent before any procedure was providing information that the “reasonable patient” would want to know. Applying that to this example- would a “reasonable patient” want to know that neck manipulation has been linked to stroke? In this case, stroke can be fatal or debilitating, so regardless of how rare it is, a “reasonable patient” would definitely want to know about it. The practitioner’s belief in the strength of the link is not really that relevant- if the condition is very, very rare but serious, you must inform the patient of the risk.

    I’m not from the US and I don’t know how your insurance system works, but I would have thought that if mrbuster’s girlfriend was not informed of the risk before the procedure, the chiropractor has not obtained informed consent. The chiropractor’s insurer would likely be interested in settling out of court because the issue is clearcut, and the potential for a court awarding very high costs against the chiropractor must be very high, assuming she was young and healthy before the stroke.

    P.S- mrbuster- I hope your girlfriend makes a full recovery quickly. I’d urge you and her to consider visiting the chiropractor afterwards and explain what happened. I suspect that he/she will be devastated to hear what happen, and it may lead to them changing their practice.

  76. pmoran says:

    I am afraid there is an error in your last post, JMB.

    Nobs and ntwk love the Cassidy study, despite the admission of its authors that it does not prove cmt to be safe, so I am sure they will be able to quickly point the error out.

  77. JMB says:

    @pmoran

    It wouldn’t be my first error. I didn’t pay for the full article. I commented on the methods reported in the summary available from Spine, lww

    http://journals.lww.com/spinejournal/Abstract/2008/02151/Risk_of_Vertebrobasilar_Stroke_and_Chiropractic.19.aspx

    I see there is an erratum in which a table is cited for stroke 0 to 7 days after visit. Perhaps that is the error you have noted for me.

    Granting that I may be wrong about the consideration of temporal relationship, I still have two other concerns about the study. I am still concerned about the method of identifying whether a vertebrobasilar stroke was related to an arterial dissection or other etiology. Perhaps the article discussed whether all cases in patients less than 45 were angiographicly (either standard, CTA, or MRA) confirmed. I also think there has to be caution about the criteria for identifying a patient as having a vertebrobasilar stroke. For scientific evaluation, it should be confirmed by imaging, or at least a neurologist. Perhaps those concerns were addressed in the full article?

    If I were to design a population study, I would select those patients who experience a sharp increase in pain during the visit to either type of provider, and who had angiographicly demonstrated vertebral artery dissection.

    In conventional science based medicine, we will use case reports to decide what to include in informed consent (however, informed consent does vary considerable from provider to provider). We will even use them to decide whether to obtain more tests. Of course, that does lead to inefficiencies to perform so many tests for the benefit of so few (but what a benefit to those few). EBM will do away with that.

  78. JMB says:

    There is one other question about the methodology of Cassidy’s study. If the study did consider the time frame from 0 to 7 days, then the visit to the PCP physician on day 0 may have been the visit that the diagnosis of a possible vertebrobasilar stroke was made, and the patient sent to the hospital. So the methodology would have to show some consideration of whether the patient was admitted to the hospital after the visit on day zero, before or after some other therapy was instituted.

  79. nwtk2007 says:

    JMB, interesting points about the methodology of the Cassidy study. But either way it might have been done, truly linking the stroke to CMT vs a visit to the PCP is futile. The patients went to the chiro or PCP for the same complaints. I would ask, also, if the PCP chould have been able to diagnose the apparent risk of oncoming stroke.

    Mark, about informed consent, do you think the informed consent on bottles of ibuprofen clearly indicate the risk? If the warning on the bottle clearly stated that ibuprofen was the number two cause of peptic ulcer, would it be a more effective informed consent. Likewise, if it indicated that ibuprofen was considered by the medical community to be resposible for the deaths of a few thousand people each year, would that also make it a more credible informed consent, considering the call for improved informed consent for something not proven and only scantly indicated as CMT and the risk of stroke?

  80. Calli Arcale says:

    Personally, I’d be in favor of having OTC drugs made to include all the same warnings as their prescription-only counterparts. So yes, ibuprofen’s packaging (or an insert) should indicate that it is a risk factor for peptic ulcer. That it doesn’t showcases the deficiencies in the system.

    When I had my last upper endoscopy, I was informed of even very rare risks. The same was true when I received my 2009 H1N1 vaccination. My prescription medications all include lists of adverse effects, including those which are very rare, but particularly highlighting the serious ones. I think that at a minimum, such language should also be used by chiropractors (or their assistants) as they prepare to perform cervical manipulation.

    To me, this seems like a no-brainer. Chiropractors seem to be mainly worried that people will stop going to see them if they are aware of risks. But informed consent hasn’t stopped people getting much more dangerous elective surgical procedures performed, so I hardly think people with splitting headaches are going to stop getting their spines adjusted after being informed that there are possible risks. I mean seriously; if you get a bad enough headache, you’d put a bullet in your foot if you thought it would help; patients will certainly accept the risk of stroke to treat their headaches. So your business will not suffer. But, when those rare adverse effects happen, patients will be well enough informed that they can get to an ER and have it treated in time. And we (meaning society) will be able to better understand how often the adverse effects happen and whether or not techniques need to be altered or, if it proves particularly dangerous, abandoned altogether.

  81. mark says:

    @nwtk2007

    The onus is on the prescriber or practitioner to obtain informed consent before prescribing a medication or performing an intervention. So if a person sustained a peptic ulcer while taking ibuprofen and the practitioner hadn’t warned the person of that risk, their position would be indefensible. Just like a doctor who does not obtain informed consent before performing a procedure or a chiropractor who does not obtain informed consent before manipulating a neck.

    Again, what potential risks need to be discussed is determined by what a reasonable patient would want to know. If the risks are serious- such as a stroke, or death etc, then they should be discussed, even if they are only theoretical or very rare.

  82. nwtk2007 says:

    So who is the “onus” on when a person self prescribes based upon TV marketing of OTC meds which are so dangerous, like ibuprofen?

    I have no problem telling a “resonable” patient that there are some out there who believe there is a risk of stoke with CMT, how ever slight the risk might be. Don’t you think the true risks associated with ibuprofen should also be made known? All OTC meds for that matter?

    And shouldn’t it be painfully clear in light of the fact, and I say fact, that so many lack the education and basic knowledge to truly assess the risk of these things they are willing to pop into their mouths so indescriminately?

  83. Harriet Hall says:

    nwtk2007 still doesn’t understand why tu quoque is a logical fallacy. You can complain all day about NSAIDS, but that does nothing to exonerate neck manipulation. And telling the patient “there are some out there who believe there is a risk of stoke with CMT” is just the kind of self-serving weasel-wording that many chiropractors are using to pretend that they are getting informed consent when they are really trying to influence the patient. MDs don’t minimize the risks of NSAIDS by saying “there are some out there who believe there is a risk of death from NSAIDS.”

  84. mark says:

    @ nwtk2007

    I’m not sure where you are going with the ibuprofen/OTC analogy. Obviously, if something is self-prescribed the issue of a practitioner obtaining informed consent is irrelevant. I agree with you about the difficulties of communicating risks to individuals who chose to self-prescribe. As Calli Arcade says, you can have the information in the packaging or insert, but as you point out, the person may not read or understand it.

    However, coming back to the issue, which is about a practitioner obtaining informed consent before a procedure. I agree with Harriet that you would need to be very careful phrasing your words in that way. The test for informed consent is providing information that the patient needs to know. If a practitioner used that phrase, and a patient later formally questioned whether informed consent had been obtained, I suspect most formal authorities would say that it hadn’t. The practitioner would then find him/herself in an indefensible position if a stroke did occur after the procedure.

  85. nwtk2007 says:

    I’m not tu quoque’ing. I’m compairing the need and the level of urgency of the informed consent related to the risks of CMT vs the risks of ibuprofen. I’m not saying that since the informed consent for ibuprofen risk is insufficient that the chiros shouldn’t have to be sufficient in their informed consent as relates to the risks of CMT. Not saying that at all.

    I’m just comparing the two. One is a proven killer and harmer of people, without doubt, however rare it might occur. The other is of questionable risk and if actually a risk, much rarer than the risk of the other.

    Just compairing and wondering why the level of urgency for informed consent isn’t just as comparable.

    I also wouldn’t say that chiro’s weasal word the risk. By SBM standards, there is simply no concrete evidence that CMT causes stroke. None. Just stories and questionable studies where the data can be interpreted in many ways, where the “link” between the two is highly questionable and insufficiently investigated by the one who provides the “opinion” that a CMT has caused a stroke.

    nobs explained a good bit of this earlier on and I’ll not reitterate it again and again.

    Informed consent is fine, I have no problem with it. It won’t effect the business or peoples choice of one treatment over another as relates to chiropractic. But I am willing to bet that if the death statistics associated with ibuprofen and its level of risk associated with gastric ulcer were presented in anything by “fine print” on a little piece of paper annoyingly folded up almost too tightly to unfold, the sales of ibuprofen would plummet. As it is right now it is comparable to the disclaimers read at lightning speed at the end of many radio advertisements.

    If the chiro’s informed consent were presented in such a way, the outcry of many of the SBM’ers here would be incredible.

    Call it tu quoque or what ever, it doesn’t matter. Out cry for informed consent related to the risks of CMT by many medical professionals is tantamount to the proverbial pot calling the kettle black.

    One more thing, I’m thinking that if a doctor causes harm to a patient, even if there is informed consent as to the risks, he/she is still in an indefensible position. The lay-public simply lacks the education and the understanding to make informed decisions related to most things health and medically related. In any malpractice proceeding, the informed consent would be the very first thing a plaintifs attorney would dispense with. Juries can be convinced of many things which do not jive with “assumed” justice and/or justifyable actions.

  86. pmoran says:

    “By SBM standards, there is simply no concrete evidence that CMT causes stroke.”

    And there never will be, if the standard you demand is multiple prospective randomised controlled trials of a size large enough to demonstrate what is admittedly a very small, but serious, risk in patients with no solid justification for the procedure.

    That is not the same thing as “no evidence” .

    There are the regularly occurring “smoking gun” cases which first drew attention to the problem and that you seem unable to grasp the significance of with such an extremely rare condition in the young, and the strong statistical associations in every study that has looked for them, including the Cassidy study.

    Only some of that association could be due to patieints with early symptoms of VAD attending chiropractors. Some of the smoking gun cases had no relevant symptoms.

    What’s more, Cassidy’s own figures show that a patient with a “headache or cervical” problem is at least four times more likely to see a PCP than DC. Allowing for that would completely eliminate the supposedly similar association of stroke with PCP visits. I cannot see where that has been allowed for. Can you?

  87. marcus welby says:

    nwtk2007: NSAIDs provide benefit beyond placebo for a number of conditions and relieve pain far more than placebo or they would not have been able to be prescribed and sold for that purpose. Chiropractic neck manipulation has not been shown to be better than placebo by evidence based medical standards, and on rare occasions kills or maims. Practically every MD who has studied this issue, which now includes almost all ER physicians, neurologists, neurosurgeons, stroke physicians of any type, those who come in contact with stroke victims and also understand the distinct anatomy of the C-1/C-2 articulation and the vertebral artery, knows the connection between chiropractic neck manipulation and stroke is real and a danger. None of those MDs, I would venture to say, would countenance advising anyone to have a chiropractic neck manipulation. Anyone who understands the anatomy and has a sense of biomechanics who has watched a chiropractic neck manipulation as shown on some of the You Tube chiropractic advertising videos listed above, would consider recommending such a procedure…no benefit beyond placebo, small but real risk of stroke or death. True informed consent is the bare minimum which should be demanded of the profession. Chiropractors keep hanging their hat on the Cassidy study, lead by a chiropractor who admitted at one time he had caused a stroke in a patient but now evidently retracts that admission, has multiple flaws, shows an association in young people between chiropractic neck manipulation and stroke (that is where the primary risk exists…so including a bunch of older folks in the study population dilutes this relatively rare event so much as to make it appear stroke is less likely), did not search for diagnostic codes for Vertebral Artery Dissection (the primary pathologic cause for the stroke following neck manipulation), examined not one patient (just discharge diagnoses) and still admitted strokes were a 4 fold risk in young people if their neck had been manipulated. The Cassidy study should be recognized for what it is…
    I tell all patients who insist on seeing a chiropractor: ” just don’t let them touch your neck.” And I am serious.

  88. mrbasher says:

    What if we look at this at a higher level?

    Is it possible that if done correctly 100% of the time, there would be no chance of dissection?

    Is it possible that if not done correctly, a chiropractor could cause a dissection?

    Should a chiropractor be expected to do whatever is necessary to avoid the risk of causing a dissection?

    I do not believe anyone is saying that CMT = dissection/stroke, in fact I haven’t seen this stated on even the most biased sites I have seen. Everything I have read is attempting to point out an associated risk, which seems obvious… even to the lay-person. You won’t catch me cracking my own neck anymore either, for the very same reason.

    I’ll tell you what I do see… I see chiropractors giving the following defense, repeatedly: “It could have been anything.” Which is entirely true… However, “anything” does not exclude CMT. Unless of course, chiropractors do it right 100% of the time… Do they? :)

  89. marcus welby says:

    Mr. Basher: as one who has followed this issue closely for years, the answer is that the risk of vertebral artery dissection and then serious neurologic harm or death is on the order of one in thousands of neck crackings. However, there are over a million of these done annually in the U.S. and Canada, I am informed. Many chiropractors use this procedure to treat every condition which presents itself to their office: I have seen permanent neurologic injury from neck cracking to treat tailbone pain and shoulder pain and low back pain, and death from neck cracking to treat some of the same conditions. Sometimes seizures occur on the treatment table and most develop symptoms within 24 hours, but because a clot can occur at the site of the torn artery, delay of up to a month or more does occur. It is not a matter of the procedure being done properly, since the chiropractors wish to elicit the “pop” of sudden negative pressure within neck vertebral joints resulting in nitrogen gas appearing, like cracking one’s knuckles. A slow and safe neck manipulation which some chiropractors and most physical therapists use, would not produce the impressive “pop” which makes the patient think something important has happened and that something must have been out of place.
    Put another way, a safe neck manipulation would be performed slowly and gently and would be described better as gentle immobilization. Akin to massage therapy, which is safe. Chiropractors, as seen on this blog, seem unwilling to admit there is any risk, nor to warn patients of that risk. Those MDs who treat stroke victims know better. In my opinion, the high velocity neck maneuver favored by many chiropractors and also practiced by many MDs in Germany should never be performed for any reason. No demonstrated benefit. No plausible reason why it would help anyone. Rare risk of stroke or death.

  90. nwtk2007 says:

    Mr Welby, I am not believing what I am reading. I am beginning to think you might be as ficticious as mrbasher. You certainly sound much the same as I have experienced in reading other blogs where failed chiro’s pretend to be doctors, pt’s and nurses who repeat the same jargon and have, in some instances, been exposed as ficticious imposters. At the very least some of your comments are exact copies of many on these blogs I mention.

    marcuswelby – “as one who has followed this issue closely for years, the answer is that the risk of vertebral artery dissection and then serious neurologic harm or death is on the order of one in thousands of neck crackings. ”

    If you have, indeed followed this issue for years, then you would be more acurate. Even if the alleged stroke were caused by CMT, the risk has been estimated from one in a million to one in ten million.

    marcuswelby – “However, there are over a million of these done annually in the U.S. and Canada, I am informed.

    What a bogus attempt to be taken seriously and to be seen as genuine. Informed where? In the coffee shop? At the barber shop? Do you mean you have read it?

    marcuswelby – ” I have seen permanent neurologic injury from neck cracking to treat tailbone pain and shoulder pain and low back pain, and death from neck cracking to treat some of the same conditions. ”

    Yeah right. Where? When? More fiction from the coffee shop? If, indeed, you are a doctor, did you report it? What became of it?

    marcuswelby – “Sometimes seizures occur on the treatment table and most develop symptoms within 24 hours, but because a clot can occur at the site of the torn artery, delay of up to a month or more does occur.”

    What a bunch of fiction. You know this to be fact? How do you know it?

    marcuswelby – “Those MDs who treat stroke victims know better.”

    Really? Are you one of those? If you hear the word chiropractor, do you investigate any further at all?

    The way you speak of it just cries “fiction”. And that’s pretty much the way I have seen it argued in most places. I’ve seen this or I’ve seen that.

    I’ll stick with the studies discussed here and leave it at that. I left this blog for a year because there just wasn’t anything more coming up about it. It’s still the same. The court cases are public record and will eventually either go away or be decided. My guess is there will be no definative studies ever nor any agreement with any resultant studies that might be performed.

    If the risk is as it is discussed here, then there will be new law suits and many more real cases appearing in the news. We’ll see.

  91. Harriet Hall says:

    nwtk2007 said “The way you speak of it just cries “fiction”.

    The way nwtk2007 speaks just cries “desperate rationalizations trying to defend a lost cause.” Apparently he won’t believe neck manipulation can cause a stroke until he is confronted with some kind of “perfect” evidence. And yet he seems to think new lawsuits and cases in the news would constitute acceptable evidence. Does he really? How many lawsuits and news stories does it take to add up to evidence? Why aren’t the existing ones sufficient? The rest of us are concerned enough about patient safety to accept the existing evidence.

  92. pmoran says:

    Marcus Welby: “I’ll tell you what I do see… I see chiropractors giving the following defense, repeatedly: “It could have been anything.” Which is entirely true… However, “anything” does not exclude CMT.”

    Actually that’s not “entirely true”. I’ve been meaning to point out that the several case control studies should control for the “anything”, meaning the other possible triggering events of VAD that chiropractors like to raise.

    In any case, it is ridiculous for them to be claiming that sneezing and drying the hair can cause stroke, but neck manipulation can’t.

  93. nwtk2007 says:

    Why not continue to twist my position. I have pointed out that there is literally no solid evidence that CMT causes these strokes and that repeatedly, the other possible causes are ignored or not considered.

    I don’t expect perfect evidence, just objective assessment of it. Failure to consider the other possible causes that have been mentioned, even when there is no CMT performed, is to me, unscientific thinking.

    In the words of pmoran, it is “ridiculous” NOT to think that activities which are even more violent in their neck motions would not be possible causes.

    Total BIAS. Not science based thinking.

  94. Harriet Hall says:

    nwtk2007,

    Didn’t you understand pmoran’s point? The controlled studies constituted “considering that there could be other possible causes.”

  95. pmoran says:

    “Why not continue to twist my position. I have pointed out that there is literally no solid evidence that CMT causes these strokes and that repeatedly, the other possible causes are ignored or not considered.”

    That is PRECISELY the position that gives us concern, if it is guiding chiropractic’s response to the matter. The “other possible causes” is ridiculous, considering the details of many of the cases that occur while still on the chiropractor’s table, or in a doctor’s office, as in one local case.

    But be it on your own head. Ignoring the matter can only add to a generally low regard for the professionalism of many chiropractors.

  96. JMB says:

    Arterial dissection is a recognized complication for any procedure involving an intra-arterial catheter. The majority can be recognized at the time of catherization, and treated with anticoagulant therapy to minimize the risk of infarction from the dissection. The occurrence of dissection during a procedure is not considered a breach of the standard of care (unless it happens much more frequently than the norm). What is considered a breach of the standard of care is the failure to recognize and treat the complicating dissection.

    If chiropractors get hung up on the issue of scientific proof, they may miss the opportunity in the rare patient that suffers a vertebral artery dissection to minimize the risk of stroke, or minimize the deficit resulting from the stroke. Early intervention can improve the outcome. Don’t worry about scientific proof when the patient is in front of you exhibiting the symptoms of a vertebral artery dissection or stroke, just get the patient to the hospital for confirming tests and anticoagulants. Nowhere in SBM is there an axiom that says, “Don’t treat if there is no evidence from Randomized Clinical Trials.”

    Is it better for the chiropractor’s profession to argue that scientific evidence does not exist… or that there is anecdotal evidence that it may occur rarely following cervical manipulation, so it is important for chiropractors to learn the symptoms of arterial dissection and vertebrobasilar stroke so that early intervention can minimize the long term sequela.

  97. Blue Wode says:

    In view of the rational contributions here which clearly indicate an unfavourable risk/benefit profile for neck manipulation, it’s disappointing to see a new article in Chiropractic & Osteopathy that strongly suggests that stroke after neck manipulation is coincidental:
    http://www.chiroandosteo.com/content/18/1/22

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