Recently the tragic and untimely death of Katie May in February 2016 has made headlines and the media is painting chiropractic spinal manipulative therapy (SMT) as the culprit. Unfortunately, this scenario happens from time to time. In fact, large scale studies have shown that is happens somewhere between one in a million to one in four million times that a cervical or neck adjustment is given. The interesting part is that the numbers are the same with regards to visits to a primary care physician where no adjustment is given. This makes vertebrobasilar stroke a known risk after cervical adjustments and visits to the doctors office.
What Does That Mean?
OK. (deep breath) What you really need to know is how vertebrobasilar stroke different from a more traditional stroke.
Strokes happen in two ways.
1) We develop a blood clot (thromboembolism) which travels to the brain and cuts off blood supply (ischemic stroke).
2) One of the arteries in the brain ruptures (hemorrhagic stroke).
The ischemic variant is much more common and accounts for roughly 80-85 percent of all strokes. Vertebrobasilar stroke is a rare but deadly form of ischemic stroke that follows vertebral artery dissection. Katie May was found by the coroner to have suffered this type of stroke.
If you want to become an expert and have a ton of time to kill you can visit:
for more on vertebral artery dissection and
for more on vertebrobasiliar stroke.
I'm going to give you the highlights (you're welcome). Vertebral artery dissection often begins as severe posterior neck pain and occipital headache and as the vertebrobasilar stroke begins things escalate into serious neurological symptoms which are easy to identify and any doctor should be able to pick them up. However, the neck pain and headache are common in chiropractors offices, doctors offices and hospitals making them an unreliable indicator for such a rare type of stroke.
So does that mean that the adjustment caused her stroke?
Fear mongering aside, there is no way to know for sure. In such rare cases where a patient has neck pain and headache due to a vertebral artery dissection that hasn't progressed into a vertebrobasilar stroke the studies indicate that it doesn't matter whether she went to her chiropractor or her primary care physician the outcome would have likely have been just as tragic.
What can we all take away from this?
Doctors of all kinds must pay close attention to detail when treating patients with these types of symptoms and neurologic signs associated with stroke should not be ignored no matter how subtle. It is important to keep in mind just how rare an incident this really is, despite the headlines. Perhaps the fact that adjustments are so widely known to be safe is why this makes such an attractive story to the media who is always looking for the next shocker. Always keep things in perspective.
Always, Always, Always ask questions!
Dr Malone DC