The Relationship of Chiropractic Neck Manipulation to Internal Carotid Artery Dissection

Abstract: Forensic experts may be requested to offer an opinion regarding the relationship between cervical chiropractic manipulative therapy (CMT) and subsequent internal carotid artery dissection (ICAD). For the most part, the medical literature contends that cervical CMT may be a cause of ICAD. The proposed mechanism of traumatically induced ICAD involves a sudden, severe stretch of the internal carotid artery (ICA) over the upper cervical spine when the neck is hyperextended and laterally flexed or rotated to the opposite side. However, most ICADs are spontaneous, with no identifiable pre-morbid trauma. In cases where adverse symptoms of ICAD did not occur within a relatively close temporal relationship to the cervical CMT, there will always be doubt about its connection with ICAD. Patients who have an associated primary arterial disease, which is often present in ICAD patients, are at risk when subjected to virtually any sort of head or neck motion.