Cerebral embolus following chiropractic manipulation in a patient with a calcified carotid artery

J Neuroimaging. 2013 Jul;23(3):429-30. doi: 10.1111/j.1552-6569.2012.00706.x. Epub 2012 Jul 20.


Background and purpose: Dissection of the cervicocranial vessels is the principal cause of ischemic brain injury following cervical spinal manipulation. Cervical spinal manipulation leading to cerebral embolus in the absence of dissection is not described in the literature. Current case documents cerebral embolism originating from extensively calcified internal carotid artery immediately following cervical spinal manipulation in the absence of dissection.

Methods: We describe a case and imaging findings of a 63-year-old male who underwent cervical spinal manipulation and developed sudden onset of left-arm numbness and weakness.

Results: Computed tomography angiography demonstrated extensively calcified right internal carotid artery at the site of redone carotid endarterectomy as well as calcified embolus in the right inferior middle cerebral artery.

Conclusions: Calcified carotid artery may be at risk for embolization following cervical spinal manipulation. Our recommendation is that, patients with extensively calcified carotid arteries should refrain from aggressive neck maneuvers and cervical spine manipulation therapy to avoid liberation of cerebral embolus.

Keywords: Calcification; cervical manipulation; embolus; spine; stroke.

Publication types

  • Case Reports

MeSH terms

  • Calcinosis / complications*
  • Calcinosis / diagnosis*
  • Carotid Artery Diseases / complications*
  • Carotid Artery Diseases / diagnosis*
  • Cerebral Angiography
  • Diagnosis, Differential
  • Humans
  • Intracranial Embolism / diagnosis*
  • Intracranial Embolism / etiology*
  • Male
  • Manipulation, Chiropractic / adverse effects*
  • Middle Aged
  • Treatment Outcome