This case involves a male patient in Wisconsin in his mid 20’s with a history of back pain that was being managed through chiropractic spinal manipulation. Following one of his sessions, the patient experienced vertigo, nausea, and chills as soon as he left the chiropractor’s office. He immediately returned to the chiropractor that had performed the manipulation with his concerns, and was told to lie down for a few moments. The chiropractor suggested that the symptoms were likely due to a migraine headache unrelated to his treatment. He departed the office with the assistance of his mother, as by this point he was having difficulty with his balance. After driving to the emergency room, the patient was diagnosed with a cerebellar stroke likely caused by the earlier chiropractic manipulation.
Question(s) For Expert Witness
- 1. Do you routinely perform manipulations for back pain?
- 2. Have you encountered this complication in your practice or in other cases you have reviewed?
Expert Witness Response E-096151
I do perform manipulation for back pain and cervical manipulation. I have not encountered this complication personally, but I have seen it in other reviews. I have lectured previously, generally in terms of orthopedic and neurological evaluation. My initial thoughts on this case are that loss of balance, muscle weakness and vertigo are each separately worrisome signs of a cerebrovascular accident (CVA), but combined form an undeniable trifecta of sorts. Add the temporal component/ considerations and/or facts and it seems indisputable. As for my thoughts about the delay in appropriate care, it was also inappropriate and a significant departure in the expected standard of care as I know it.