Research: Stroke
Written by Craig Benton, DC   
Tuesday, April 29, 2014 02:32 PM

I hope and pray that no one has had a patient go through this.  A short story I had a guy a few years ago who came in complaining of headaches and neck pain for about two weeks.  I did an exam, x-ray, and put him on muscle stim.  While he was on muscle stim he commented to me that it really bothered him at night and he would wake up in a cold sweat.  Night sweats and back or neck pain do not bode well so I referred him to his family physician and told him something was going on.  Well an MRI later demonstrated a aneurysm in the circle of Willis.  He had surgery and did fine the MD said that I saved his life.  
 
The negative press on stroke is mostly about vertebral artery dissections.   These are extremely rare events and are much less common than a carotid artery dissection.   What happens in a vertebral artery dissection (VAD) is that there is a tear in the wall of the artery and a blood clot forms, or due to a tear there is lack of blood supply to the brain.  This can lead to a stroke.  Now two-thirds of these are spontaneous with no known cause and one-third are traumatic (auto accidents, direct blows to the neck, or strangulation, manipulation is also placed here).  I believe that VAD is one of the leading causes of stroke in people under 40 years of age.  We know the devastation that this can cause if it does occur.
 
But it is difficult to study these events because they are so rare.  Researchers could follow thousands of patients for a number of years and never come across a VAD.

So these are the kinds of studies that present in the medical literature:

 
This was later found to not be chiropractic in nature.  They are using numbers such as 1 in 10,000 to 20,000.  I believe one study showed that 1 in 20 neurologists came across this and chiropractors were more like 1 in 500.
 
So this is the best article that I have found on spinal manipulation and stroke.  It is by Donald Murphy, D.C. out of Rhode Island.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922298/.    Basically he looked at the Cassidy study and tried to explain it better.  Stating that Cassidy found the same percentage of stroke victims from chiropractic as they did in family medicine.  His suggestion was that the patient that was presenting to the DC or MD was already in the process of having a stroke (remember two-thirds of these are spontaneous).  Dr. Murphy has stated that screening techniques have not worked well for the chiropractic profession in an attempt to prevent stoke.  The research has shown that CMT is not a cause of stroke but incidental to it with the link being neck pain and headaches. Dr. Murphy has recommended that the profession would be better served by taking a proactive stance on overall  stroke detection.  Remember in some of these spontaneous cases there are no symptoms.  He has recommended adding some questions in our history for patients with neck pain and headaches.
  • Does the patient have blurred vision, double vision, trouble swallowing or speaking? 
  • Do they have dizziness, fainting spells, nausea, trouble walking or balance, numbness in both hands or feet? 

If there are several of these signs present Dr. Murphy recommends a 2 minute neurological exam (which is table two in his paper).
 
He states the chiropractic profession has the opportunity to change the discussion from one of defensiveness to one of Public health.
 
http://www.ncbi.nlm.nih.gov/pubmed/24387889
 
http://www.ncbi.nlm.nih.gov/pubmed/22994328
 
http://www.ncbi.nlm.nih.gov/pubmed/21974915
 
http://www.ncbi.nlm.nih.gov/pubmed/19251066
 
http://www.ncbi.nlm.nih.gov/pubmed/12381972
 
http://www.ncbi.nlm.nih.gov/pubmed/15726036
 
http://www.ncbi.nlm.nih.gov/pubmed/12801430
 
http://www.ncbi.nlm.nih.gov/pubmed/19221970
 
Most of these references are chiropractic in nature.  Any type of VAD is serious and it seems like knowing the signs and symptoms of stoke may protect our patients better than anything else we can do at this time.