Objective: Vertebral artery dissection (VAD) is a rare cause of stroke but increasingly recognized in patients younger than 45 years. The dissection of the inner lining of the vertebral artery leads to blood entering the arterial wall, forming clots. The majority of cases often occur after physical trauma towards the neck, such as by strangulation or blunt force. Subsequently ischemic neurologic features can occur in 30−80% of all dissections and 20% of cases can result in a complete stroke. This paper describes neuropsychological findings 3 weeks following an infarction in a 33-year old male with VAD post man manipulation. Method: The patient initially presented with symptoms of dizziness, diaphoresis, and confusion immediately following chiropractic visit. Head CT showed acute ischemic injury to both the right occipital lobe and right cerebellum. He continues to use a can occasionally, though visual difficulties have resolved. Results: Testing assessed effort, intellectual, memory, executive, language, motor, attention, and personality functioning. Examination showed average estimated premorbid IQ (TOPF SS = 100) and WAIS-IV FSIQ of 105 within the context of above average verbal (VCI = 120) and nonverbal (PRI = 115) abilities. Cognitive deficits included speeded motor dexterity (GPT RH T = 35; LH T = 35), working memory (WAIS-IV WMI = 86), processing speed (WAIS-IV PSI = 84), and verbal fluency (FAS T = 31). Conclusion: Findings are consistent with research implicating the role of the cerebellum with motor control and coordination. These results also support the notion of the cerebellum's role in verbal working memory due to implicated anatomical pathways. Overall, this case study contributes to the field underlining the complications of chiropractic manipulation.
Neuropsychological Sequelae of Vertebral Artery Dissection and Infarction Following Chiropractic Manipulation: A Case Study
S Ramocki, A Myers-Fabian; A-07
Neuropsychological Sequelae of Vertebral Artery Dissection and Infarction Following Chiropractic Manipulation: A Case Study. Arch Clin Neuropsychol 2015; 30 (6): 488. doi: 10.1093/arclin/acv047.07
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