A Population-Based Case-Series of Ontario Patients Who Develop a Vertebrobasilar Artery Stroke After Seeing a Chiropractor

      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