Vertebral and carotid artery dissection following chiropractic cervical manipulation

A 50-year-old woman presented a sudden left occipital headache and a poster ior circulation stroke after cervical manipulation for neck pain. Magnetic resonance imaging documented a left intracranial vertebral artery occlusive dissection associated with an ipsilateral internal carotid artery dissecti on with vessel stenosis in its prepetrous tract. This is the first reported case showing an associate vertebral and carotid artery dissection followin g cervical manipulation. Carotid dissection was asymptomatic and, therefore , its incidence may be underestimated. We emphasize that cervical manipulat ion should be performed only in patients without predisposing factors for a rtery dissection and after an appropriate diagnosis of neck pain.