A rare case of ischaemic stroke following cervical spine manipulation in an adolescent girl


  • Ashitha Judith Paul Department of Pediatrics, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
  • Radha Kumar Department of Pediatrics, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India




Anticoagulants, Chiropractor, Hemiparesis, Ischemic stroke, Neck manipulation, Physiotherapy


Stroke in children is associated with a multitude of risk factors compared to risk factors of adult stroke such as hypertension, diabetes or atherosclerosis. A 15-year adolescent girl presented with acute onset weakness involving right upper and lower limb. She complained of neck pain and fever 2 days before the onset of hemiparesis for which her parents took her to traditional healer who performed neck manipulation after which she developed vomiting, tingling numbness and weakness of right upper and lower limb. There was no history of preceding headache, ear discharge or any other contributory history. Clinical examination revealed Glasgow Come Scale 12/15, power of grade 2/5 in right upper limb and 3/5 in right lower limb, exaggerated deep reflexes, extensor plantar reflex, right sided ptosis and right sided upper motor neuron facial palsy. CT scan brain showed right cerebellar and occipital infarct with posterior inferior cerebellar artery territory involvement. MRI Brain and MR Angiogram showed wedge shaped infarct involving right posterior inferior cerebellum, inferior vermis, ventral aspect of superior medulla, paracentral pons, right cerebral peduncle, tectum of both halves of midbrain with no internal hemorrhage and no vessel abnormality and right vertebral artery was not visualized. Her coagulation profile and cardiac work up were normal. She was treated with antiplatelet drugs, anticoagulants and physiotherapy following which the child gradually improved over a period of one month. In this case, with a positive history of neck manipulation authors can conclude that the etiology of young stroke wasinduced byneck manipulation. This case has been reported to increase awareness about the ill effects of neck manipulation and counsel parents against performing such procedures for children. Early recognition of pediatric stroke is critical for immediate diagnosis, imaging and treatment with better outcomes.


Tsze DS, Valente JH. Pediatric stroke: a review. Emerg Med Inter. 2011:1-10.

Riela AR, Roach ES. Topical Review Article: Etiology of Stroke in Children. J Child Neurol. 1993 Jul;8(3):201-20.

Fullerton HJ, Wu YW, Zhao S. Claiborne Johnston. Risk of stroke in children. Neurol. 2003;61(2):189-94.

Rajani NK, Pearce K, Campion T, Salpietro V, Planells M, Chong W, et al. Pediatric stroke: current diagnostic and management challenges. Quant Imaging Med Surg. 2018;8(10):984-91.

Paterson JK. Adverse effects of spinal manipulation. J Royal Soci Med. 2007 Oct;100(10):445-6.

Jones J, Jones C, Nugent K. Vertebral artery dissection after a chiropractor neck manipulation. Baylor Uni Med Center Procee. 2015;28(1):88-90.

Albuquerque FC, Hu YC, Dashti SR, Abla AA, Clark JC, Alkire B, et al. Craniocervical arterial dissections as sequelae of chiropractic manipulation: patterns of injury and management. J Neurosurg. 2011 Dec 1;115(6):1197-205.

Di Fabio RP. Manipulation of the cervical spine: risks and benefits. Phys Therapy. 1999 Jan 1;79(1):50-65.

Maguire JL, deveber G, Parkin PC. Association between iron-deficiency anemia and stroke in young children. Pediatrics. 2007 Nov 1;120(5):1053-7.






Case Reports