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Chiropractic (General)

Vertebrobasilar Arterial Insufficiency, Part II

Neurological Examination Findings in Cases of Vertebrobasilar Infarct
Brad McKechnie, DC, DACAN

A review of 52 cases of vertebrobasilar infarct was performed to ascertain the frequency and types of symptoms and signs that accompanied the reported cases of infarct (1-33). In last month's column the symptoms associated with vertebrobasilar infarct were reviewed. The following is a review of the reported neurological signs associated with vertebrobasilar infarct.

# Signs noted
 
19 Cerebellar signs: ataxia, dyssynergia, dysmetria, etc.
18 Rotatory nystagmus
17 Facial nerve palsy
15 Paresthesia, decreased pain in trigeminal distribution
12 Paresthesia, decreased pain in body
 
11 Tandem gait veering
11 Asymmetrical pupils
8 Ptosis
8 Babinski's sign
8 Palatal paresis
 
6 Confusion
6 Dysarthria
6 Decreased arm/leg strength
4 Diplopia
4 Decreased corneal reflex
 
4 Cranial nerve VI palsy
4 Hyperreflexia
4 Quadriplegia
4 Visual field loss
4 Tongue deviation
 
3 Hoarseness
3 Dysphagia
2 Decreased hearing
2 Tinnitus
1 Drowsiness
 
1 Decreased position sense
1 Cranial nerve IV palsy
1 Grasp, suck reflexes
1 Respiratory paralysis

Should the chiropractic physician suspect that a patient is suffering from vertebrobasilar infarct, a neurological examination would be in order to better ascertain the extent of neurological involvement. The anatomical basis for the most common symptoms and signs of vertebrobasilar infarct will be discussed in detail in this column's next installment.

References

  1. Mueller S, Sahs AL. Brain stem dysfunction related to cervical manipulation. Neurology, 26:547-550, 1976.

     

  2. Hanus SH, Homer TD, and Harter DH. Vertebral artery occlusion complicating yoga exercise. Arch Neurol, 34: 574-575, 1977.

     

  3. Miller RG and Burton R. Stroke following chiropractic manipulation of the spine. JAMA, 229:189-190, 1974.

     

  4. Schellhas KP et al. Vertebrobasilar injuries following cervical manipulation. JAMA, 244:1450-1453, 1980.

     

  5. Smith RA, Estridge MN. Neurologic complications of head and neck manipulations. JAMA, 182:528-531, 1962.

     

  6. Daneschmend TK et al. Acute brain stem stroke during manipulation. BMJ, 288:189, 1984.

     

  7. Green D, Joynt RJ. Vascular accidents to the brain stem associated with neck manipulation. JAMA, 170:522-524, 1959.

     

  8. Zimmerman AW et el. Traumatic vertebrobasilar occlusive disease in childhood. Neurology, 28:185-188, 1978.

     

  9. Davidson KC, Weiford EC, and Dixon GD. Traumatic vertebral artery pseudoaneurysm following chiropractic manipulation. Radiology, 115:651-652, 1975.

     

  10. Terrett AGJ. Vascular accidents from cervical spine manipulation: Report on 107 cases. J Aust Chiro Assoc, 17:15-24, 1987.

     

  11. Pratt-Thomas HR, Berger KE. Cerebellar and spinal injuries after chiropractic manipulation. JAMA, 133:600-603, 1947.

     

  12. York vs. Daniels, Mediolegal abstracts. Chiropractors: injury to spinal meninges during adjustments, JAMA, 159:809, 1955.

     

  13. Bladin PF, Merory J. Mechanisms in cerebral lesions in trauma to high cervical portion of the vertebral artery -- rotation injury. Proc Aust Assoc Neurol, 12:35-41, 1975.

     

  14. Kreuger BR, Okazaki H. Vertebral-basilar distribution infarction following chiropractic cervical manipulation. Mayo Clin Proc, 55:322-332, 1980.

     

  15. Braun IF et al. Brain stem infarction due to chiropractic manipulation of the cervical spine. Souther Med J, 76:1199-1201, 1983.

     

  16. Fritz VU et al. Neck manipulation causing stroke. South African Med J, 66:844-846, 1984.

     

  17. Horn SW. The Locked-In-Syndrome following chiropractic manipulation of the cervical spine. Ann Emerg Med, 12:648-650, 1983.

     

  18. Bolton SP. Vascular accidents. J Aust Chiro Assoc, 17:75, 1987.

     

  19. Dhamoon SK et al. Ipsilateral hemiplegia and the Wallenberg Syndrome. Arch Neurol, 41:179-180, 1984.

     

  20. Bakewell vs. Kahle, Medicolegal abstract. Chiropractors: rupture of brain tumor following adjustment. JAMA, 148:699, 1952.

     

  21. Kanshepolsky J et al. Vertebral artery insufficiency and cerebellar infarct due to manipulation of the neck. Bull LA Neurol Soc, 37:62-66, 1972.

     

  22. Kommerell G, Hoyt WF. Lateropulsion of saccadic eye movements. Arch Neurol, 28:313-318, 1973.

     

  23. DeVivo DC, Farrell FW. Arch Neurol, 26:278-281, 1972.

     

  24. Brain L. Some unsolved problems of cervical spondylosis. BMJ, March 23, 1963, pp. 771-777.

     

  25. Hardin CA, Williamson WP, Steegmann AT. Vertebral artery insufficiency produced by cervical osteoarthritic spurs, Neurology.

     

  26. Bauer R, Sheehan S, Meyer JS. Arteriographic study of cerebrovascular disease. Arch Neurol, 4:119-131, 1961.

     

  27. Marks RL, Freed MM. Nonpenetrating injuries of the neck and cerebrovascular accident. Arch Neurol, 28:412-414, 1973.

     

  28. Brust JCM et al. The pathology of drop attack: A case report. Neurology, 29:786-790, 1979.

     

  29. Grayson MF. Horner's syndrome after manipulation of the neck. BMJ, 295:1381-1382, 1987.

     

  30. Roche L et al. Lesions traumatiques de la colonne cervicale et atteintes de l'artere vertebrale. Ann Med Leg, 43:232-235, 1963.

     

  31. Easton JD, Sherman DG. Cervical manipulations and stroke. Stroke, 8:594-597, 1977.

     

  32. Nyberg-Hansen R et al. Brain stem lesion with coma for five years following manipulation of the cervical spine. J Neurol, 218: 97-105, 1978.

     

  33. Ladermann JP. Accidents of spinal manipulations. Swiss Annals, 7:161-208, 1981.

Brad McKechnie, DC, DACAN
Pasadena, Texas
June 1994
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