Table 1.   Characteristics of chiropractic VBA patients in case series and survey studies

Article type
Prior health conditions
Data sources
Hufnagel et al,8 1999, Journal of NeurologyCases seriesMean age, 34.0 y (27-46 y); 70% female5 (50%) with no vascular risk factorN = 10 (8 are VBA stroke)8 with VBA stroke; onset ranging from immediate to 2 dClinical course and neuroradiological findings from 1 neurologist institute
Haldeman et al,9 2001, CMAJCase seriesMean age, 42.5 y (24 75 y); 74% female17.4% hypertensionN = 23 (over a 10-y period, 1988-1997)65% onset of stroke after neck manipulation within 20 minA chiropractic malpractice insurance carrier (CCPA); survey to 337 chiropractors
17.4% migraine
4.3% oral contraceptive use
22% smoking
0% diabetes
Haldeman et al,10 2002, Journal of NeurologyMedical legal case seriesMean age, 36.3 y (SD, 6.1 y); 64% female92% with history of head or cervical spine complaintsN = 64 (legal cases)85% of 61 cases with neck manipulation; missing information in the remaining 3 casesRetrospective medical legal review over a 16-y period, 1978-1994
48 cases with an onset of the stroke within 30 min after spinal manipulation
Reuter et al,11 2006, Journal of NeurologySurvey of all university-affiliated neurological departments within GermanyMean age, 40.0 y (SD, 11 y); 66% female61% had general cardiovascular risk factorN = 36 (from 13 neurological departments)55% of patients with clinical symptoms with VAD within 12 h after neck manipulationCountrywide survey at neurological departments of all medical schools in Germany
27% with more than 1 risk factor
17% with migraine
No neck or head trauma before chirotherapy
Lee et al,12 1995, Journal of NeurologySurvey of neurologistsAge, 21-60 y; evenly divided between men and womenInformation was not providedN = 56 (obtained from 37 neurologists)21% and 16% with moderate and severe VBA stroke; 1 deathSurvey of 37 neurologists who have seen VBA stroke followed by neck manipulation in past 2 y
Norris et al,13 2000, CMAJSurvey of stroke physiciansMean age, 44 y (16-87 y); 40% femaleInformation was not providedN = 74 (reported 72% with VBA stroke)28% with onset of stroke after neck manipulationSurvey data collected from stroke physicians