A near-fatal consequence of chiropractor massage: massive stroke from carotid arterial dissection and bilateral vertebral arterial oedema.
Timothy YapLi FengDan XuJian ZhangPublished in: BMJ case reports (2021)
A 35-year-old Chinese man with no risk factors for stroke presented with a 2-day history of expressive dysphasia and a 1-day history of right-sided weakness. The presentation was preceded by multiple sessions of neck, shoulder girdle and upper back massage for pain relief in the prior 2 weeks. CT of the brain demonstrated an acute left middle cerebral artery infarct and left internal carotid artery dissection. MRI cerebral angiogram confirmed left carotid arterial dissection and intimal oedema of bilateral vertebral arteries. In the absence of other vascular comorbidities and risk factors, massage-induced internal carotid arterial dissection will most likely precipitate the near-fatal cerebrovascular event. The differential diagnosis of stroke in a younger population was consequently reviewed and discussed.
Keyphrases
- middle cerebral artery
- internal carotid artery
- atrial fibrillation
- risk factors
- cerebral ischemia
- contrast enhanced
- case report
- chronic pain
- liver failure
- bone mineral density
- drug induced
- computed tomography
- magnetic resonance
- pain management
- white matter
- spinal cord injury
- coronary artery disease
- image quality
- multiple sclerosis
- spinal cord
- left ventricular
- functional connectivity
- muscular dystrophy
- postoperative pain
- preterm birth