1417 - Neck-flex and Stroke - A Vascular Drama: A Case of Post-Chiropractic Vertebral Artery Occlusion

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Co-Author(s)

CK

Chi Lam Kwok, DO

PM&R Resident
Nassau University Medical Center
Rego Park, New York, United States
CS

Cole Siegenfeld, n/a

OMS IV
New York Institute of Technology College of Osteopathic Medicine
Melville, New York, United States
JW

Justin Wang, MD

PM&R Resident Physician
Nassau University Medical Center
East Meadow, New York, United States

Presenting Author(s)

BF

Brent Fogel, DO

PM&R Resident
Nassau University Medical Center
Melville, New York, United States

Co-Author(s)

FB

Forrest Butensky, DO

PM&R Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
AS

Ajendra Sohal, MD

PM&R Attending
Nassau University Medical Center
East Meadow, New York, United States

Submitter(s)

CS

Cole Siegenfeld

New York Institute of Technology College of Osteopathic Medicine
Melville, New York, United States

Case Diagnosis: Vertebral artery occlusion concerning for dissection following cervical chiropractic manipulation, presenting with mild expressive aphasia.

Case Description: A 70-year-old female with hypertension and hyperlipidemia developed acute slurred speech and word-finding difficulty after chiropractic treatment. On arrival, she was alert with mild expressive aphasia and dysarthria (NIHSS 2, mRS 1), without motor deficits. Noncontrast CT and CT perfusion were negative; CTA revealed complete occlusion of the proximal right vertebral artery with hypoplastic posterior circulation and distal reconstitution, concerning for dissection versus chronic atherosclerosis. An incidental 3.5-mm left MCA aneurysm was noted. MRI brain showed no infarction; MRA confirmed right vertebral hypoplasia with possible thrombosis/dissection. The echocardiogram was unremarkable. IV thrombolysis was deferred, given nondisabling deficits and possible dissection. Neurology recommended aspirin and atorvastatin; the aneurysm was observed. Supportive measures included permissive hypertension, DVT/GI prophylaxis, and safety precautions. Rehabilitation services initiated early physical, occupational, and speech therapy. The patient remained stable with gradual improvement in aphasia.

Discussions: Cervical artery dissection (CAD) is an established cause of ischemic stroke, often in younger patients, and has been temporally associated with chiropractic manipulation. Most patients become symptomatic within hours to days. Epidemiologic studies suggest that patients often seek chiropractic care for prodromal dissection symptoms, such as neck pain or headache, rather than manipulation itself being the cause. However, case reports continue to document dissections occurring shortly after manipulation. Outcomes are generally similar between manipulation-associated and other-cause dissections, with management strategies ranging from antithrombotic therapy to endovascular or surgical intervention. Rehabilitation should be tailored to neurological deficits, with early involvement of multidisciplinary teams.

Conclusions: This case illustrates vertebral artery occlusion concerning for dissection temporally associated with chiropractic manipulation. Although rare, clinicians should maintain high suspicion for CAD when focal deficits follow manipulation. Prompt vascular imaging, individualized rehabilitation, and patient education regarding warning signs are essential for optimizing outcomes.