Identification of Internal Carotid Artery Dissection in Chiropractic Practice
SOURCE: J Can Chiropr Assoc. 2004 (Sep); 48 (3): 206-210 ~ FULL TEXT
Michael T Haneline, DC, MPH and Gary Lewkovich, DC
Palmer College of Chiropractic West,
Palmer Center for Chiropractic Research,
90 E. Tasman Drive,
San Jose, CA 95134
Internal carotid artery dissection (ICAD) is a condition involving separation of the artery’s intimal lining from its medial division, with subsequent extension of the dissection along varying distances of the artery, usually in the direction of blood flow. ICAD may produce cerebral ischemia due to occlusion of the involved artery. This occlusion may occur at or near the site of the dissection, or “downstream” as a result of embolization from a dislodged thrombus fragment. The problem any chiropractic physician faces in identifying ICAD patients is that the condition may present without any symptoms or the symptoms may appear benign (e.g., headache, neck pain or cervicogenic dizziness). Consequently, it may be impossible to identify some ICAD patients, especially in the early stages of the pathology. As the ICAD progresses and neural blood flow is compromised, the symptom picture typically manifests more completely. The chiropractic physician must be alert to characteristic findings of a progressing ICAD, since an immediate referral to a medical specialist may be required.
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From the FULL TEXT Article:
Internal carotid artery dissection (ICAD) is a condition wherein there is a separation of the artery’s intimal lining from its medial division, with subsequent extension of the dissection along varying distances of the artery, usually in the direction of blood flow. [1, 2] It has been suggested that ICAD produces stroke in 36–68% of patients as a result of occlusion of the artery at or near the site of the dissection, or embolization occurring distally from a dislodged fragment of thrombus. 
ICAD is not a rare condition, with incidence estimates exceeding 7,000 cases per year in the United States.  Accordingly, patients with this disorder may present to DCs for treatment of associated symptoms that often mimic musculoskeletal conditions. Established chiropractic patients may also develop ICAD coincidentally during their course of chiropractic management, with no relationship to manipulation. However, when ICAD is recognized, an urgent referral for a neurological and vascular evaluation is appropriate. This article summarizes the presentation, diagnosis, and proper management of patients with this potentially life-threatening condition.