Chiropractic Medicine Expert Opines on Patient Stroke After Neck Manipulation

This case involves a man in his 30’s who went to see a new chiropractor for neck manipulation for headaches and neck pain. Immediately after the manipulation, the patient complained of blurry vision, vertigo, loss of balance, and dizziness. Initially, the chiropractor did not address the patient’s complaints. After several hours, the chiropractor told the patient to go to the emergency room but did not inform him why. Upon presenting to the emergency room, the patient was diagnosed with a severe stroke.

Question(s) For Expert Witness

1. How are trainees in chiropractic taught to avoid and/or manage this complication?

2. Should the signs of a stroke be recognized? If a stroke is recognized, what should be done by a chiropractor?

3. Is there a duty to inform a patient of the risk of stroke before performing cervical manipulation?

Expert Witness Response E-096151

In addition to a very good history, there are only four or five orthopedic maneuvers to test in order to try and avoid such an occurrence. Mostly, it is unavoidable and the next best thing to do is manage it correctly. Obviously, correct management requires an immediate referral to the emergency room - without question and without hesitation. Unfortunately, most doctors panic at this point and only add to the delay in the patient receiving appropriate treatment. Specifically, in the case of a stroke, a neurological evaluation and/or the consideration of a possible TPA injection take precedence. Signs of a stroke should be obvious and should be well known to the average practitioner. Again, however, panic and in this case denial usually sets in. The doctor usually starts thinking about his own behind and stops thinking about what's best for the patient. Obviously, the referral is what's best for the patient and any delay also does not serve the patient's best interests. In many states there is a duty to inform the patient.