Neck Injuries: Stroke Risk And Prevention

A stroke is a life-threatening medical condition that occurs when there is a blockage in an artery that supplies blood to the brain, or when such an artery bleeds into the brain tissue. Strokes can be caused by a tear in one of the neck's main arteries, known as a cervical artery dissection. This can be triggered by quick, jolting neck movements, such as those performed by chiropractors and other care providers. While cervical artery dissections are rare, occurring in about 2 to 3 per 100,000 people annually, they are a leading cause of stroke in individuals under 50.

Vertebral artery dissection

VAD occurs when there is a tear in the vertebral artery wall, causing blood to leak out between the layers. This can lead to the formation of a blood clot, which may break off and lodge in a brain artery, resulting in a stroke. The vertebral artery, which supplies blood to the neck vertebrae and the lower brain, typically runs through the vertebra on each side of the neck.

VAD can be caused by incidental minor trauma or neck distortion, such as chiropractic manipulation, bending of the neck, or blunt trauma. It can also occur spontaneously, though many patients with spontaneous VAD have a history of trivial or minor injuries involving some degree of cervical distortion. Risk factors for VAD include spinal manipulation, vertebral artery hypoplasia, hypertension, oral contraceptive use, chronic headache syndromes/migraines, intrinsic vascular pathology, fibromuscular dysplasia, cystic medial necrosis, and postpartum.

The typical patient with VAD is a young person who experiences severe occipital headache and posterior nuchal pain following a head or neck injury. Neurological symptoms may be delayed and may not be present at all. However, when they do occur, patients often report symptoms such as lateral medullary dysfunction (Wallenberg syndrome), ipsilateral facial dysesthesia, dysarthria or hoarseness, contralateral loss of pain and temperature sensation, diplopia, dysphagia, and unilateral hearing loss.

Diagnosis of VAD can be made through imaging studies such as computed tomography (CT) scanning, magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA). Treatment options include anticoagulant and antiplatelet therapy, with the goal of preventing stroke, which is the main complication of VAD. In some cases, endovascular or surgical treatments may be necessary for patients with concomitant complications or those who do not respond to medical therapy.

Cervical artery dissection

The two pairs of blood vessels in the neck—the carotid and vertebral arteries—are known collectively as the cervical arteries. They carry blood to the brain. A tear in the lining of one of these vessels is called a cervical artery dissection. Blood leaks between the layers of the artery wall and forms a clot. The clot may completely block blood flow through the artery or break off and lodge in an artery in the brain, resulting in a stroke.

• High-impact injury from an accident, such as a car crash.
• Minor neck injury from sports like running, yoga, or volleyball.
• Neck strain from activities such as painting a ceiling.
• Coughing, blowing your nose, or sneezing.

The symptoms of cervical artery dissection can vary from person to person and depend on the severity of the artery damage. They can also depend on whether a stroke occurs afterward. Some common symptoms include:

• Severe and sudden head or neck pain.
• Stroke-like symptoms, such as numbness and weakness on one side of the body, difficulty speaking, loss of sight in one eye, and problems with coordination.
• Horner's syndrome, which includes symptoms such as drooping eyelids, a smaller pupil in one eye, and a lack of sweating.

If you experience any of these symptoms, especially if they come on suddenly or develop after a neck injury, it is important to seek emergency medical help.

Chiropractic adjustments

Cervical artery dissection is a tear in the lining of the arteries that supply blood to the brain. This tear can cause blood to leak into the artery wall, forming a blood clot. The clot may then block blood flow through the artery or break off and lodge in a brain artery, resulting in a stroke. While cervical artery dissections are rare, occurring in about one to three per 100,000 people per year, they are a common cause of stroke in people under 50.

The risk of cervical artery dissection and subsequent stroke from chiropractic adjustments is a controversial topic. Some studies have shown a link between chiropractic neck manipulations and cervical artery dissection, but it has been challenging to prove a causal relationship. The American Heart Association (AHA) has warned that people at risk of cardiovascular disease should be cautious about receiving cervical manipulative therapy. However, the National Center for Complementary and Integrative Health states that spinal manipulation by a properly trained and licensed professional is relatively safe.

To reduce the risk of cervical artery dissection and stroke, it is recommended that individuals seek treatment from a licensed and experienced chiropractor who collaborates with a primary care physician. It is also essential to be aware of the signs and symptoms of cervical artery dissection, which include unusual, persistent, and severe neck and head pain, as well as stroke symptoms such as dizziness, double vision, jerky eye movements, unsteadiness, and slurred speech. If any of these symptoms occur, immediate medical attention is necessary.

While chiropractic adjustments can provide relief for neck pain, it is crucial to weigh the potential risks and benefits. Individuals should consult with their healthcare provider to determine if chiropractic care is appropriate for their specific situation and to ensure safe and effective treatment.

Stroke symptoms

A stroke occurs when blood flow to the brain is blocked or a blood vessel bursts. This can be caused by a tear in the lining of one of the main arteries that carry blood to the brain, known as a cervical artery dissection. While cervical artery dissections are rare, they are a notable cause of stroke in younger people and can be caused by quick, jolting neck movements.

• Weakness or numbness on one side of the face or in one arm or leg
• Confusion, trouble speaking, or trouble understanding speech
• Trouble seeing in one or both eyes
• Trouble walking, dizziness, or lack of balance or coordination
• A severe headache with no other cause
• Unusual, persistent neck pain, often accompanied by a severe headache
• Double vision or jerky eye movements
• Slurred speech or difficulty speaking
• Unsteadiness while walking
• Vomiting, nausea, fever, hiccups, or trouble swallowing
• Loss of bladder or bowel control
• Loss of bone density or strength, usually on one side of the body
• Muscle weakness or inability to move
• Problems with language, thinking, or memory
• Seizures
• Swelling in the brain
• Loss of vision, hearing, or touch
• Difficulty swallowing
• Difficulty speaking

If you or someone you know is experiencing any of these symptoms, it is important to act quickly and call for emergency medical help. The FAST test can help you remember what to do:

• F — Face: Ask the person to smile and check if one side of the face droops.
• A — Arms: Ask the person to raise both arms and check if one arm drifts downward.
• S — Speech: Ask the person to repeat a simple phrase and listen for slurred or strange-sounding words.
• T — Time: If you observe any of these signs, call an ambulance immediately. Every minute counts when it comes to treating strokes.

Stroke treatment

While a neck injury can cause a stroke in rare cases, the occurrence of a stroke is a medical emergency that requires immediate attention. Here is an overview of stroke treatment:

Recognizing a Stroke

It is crucial to be able to identify the signs and symptoms of a stroke. Use the acronym BE FAST to remember the key indicators:

• Balance: Watch for a sudden loss of balance.
• Eyes: Look for a sudden loss of vision or double vision in one or both eyes.
• Face: Ask the person to smile and observe for a droop on one or both sides of the face, indicating muscle weakness or paralysis.
• Arms: Check for one-sided weakness by asking the person to raise their arms; if one arm sags and drops, it suggests a potential stroke.
• Speech: Strokes often cause difficulty in speaking, such as slurred or garbled speech.
• Time: Time is critical; call emergency services immediately if you observe any of these signs.

Emergency Medical Response

If you or someone you know shows signs of a stroke, immediately call the emergency services (911 in the US). The quick response and treatment of a stroke can significantly impact the chances of recovery and prevent lasting brain damage or death. When calling for an ambulance, provide as much information as possible to help guide the emergency workers in their treatment approach.

Hospital Treatment

Upon arrival at the hospital, the medical team will assess your condition and may perform brain scans to determine the type of stroke you have had. The treatment will depend on the type of stroke:

• Ischemic stroke: This type of stroke is caused by blocked blood vessels in the brain, often due to blood clots. Treatment aims to restore circulation to the affected areas of the brain. Thrombolytic drugs, such as tissue plasminogen activator (tPA), are used to break up blood clots and improve recovery outcomes.
• Hemorrhagic stroke: This type of stroke involves bleeding in or around the brain. Treatment focuses on stopping the bleeding and reducing blood pressure to prevent further bleeding. Endovascular procedures or surgery may be necessary to repair damaged blood vessels or stop bleeding.

Rehabilitation and Recovery

Stroke rehabilitation is a crucial aspect of treatment and helps individuals regain abilities and adapt to changes in their brain. Rehabilitation may include:

• Speech therapy: To improve language, speaking abilities, and control of muscles related to breathing, eating, drinking, and swallowing.
• Physical therapy: To improve movement and coordination, particularly in the hands, arms, feet, and legs.
• Occupational therapy: To retrain daily activities such as eating, drinking, dressing, and writing.
• Cognitive therapy: To address memory problems and difficulties with focus or concentration.

The recovery time after a stroke varies from person to person and can take weeks, months, or even years. Some individuals may recover fully, while others may experience long-term or lifelong disabilities. It is important to work closely with your healthcare team to develop a treatment plan and make recommended lifestyle changes to lower the risk of another stroke.

Frequently asked questions