Recognition of Perinatal Stroke in a Chiropractic Practice: Case Report and Clinical Challenges Related to a Late Diagnosis

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J Clin Chiro Peds 2012 (Jun); 13 (1): 958–967 ~ FULL TEXT

Lise Hestbaek, PhD, Annette Jørgensen, DC, and
Jan Hartvigsen, PhD

Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark

Introduction:   In recent years, improvements in medical techniques and technology have enabled primary health care practitioners to diagnose perinatal strokes in infants far earlier than ever before. This new technology can also support chiropractors, especially those working with pediatric patients, in order to validate their diagnosis when they recognize these initial symptoms.

Objective:   The aim of this paper is to raise awareness and assist doctors of chiropractic in recognizing the physical and behavioral signs of perinatal stroke as they present in a chiropractic office for assessment and treatment. The paper will relate the case of a
7-month-old infant who, after visiting a chiropractic office with apparent hemiparesis and delayed developmental milestones, was post-medically diagnosed as having suffered a presumed perinatal stroke.

Discussion:   Early recognition of perinatal stroke is vital since late diagnosis can lead to a lifetime of debilitating neurological conditions as well as potential increased direct and indirect costs to society. For those who receive a late diagnosis, a chiropractor, as a member of a multidisciplinary team, can play a major role in rehabilitation by supporting the function of the nervous system,
reducing muscle and joint rigidity and optimizing neuronal plasticity.

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Conclusion:   It would be prudent for chiropractors to receive more training in the detection of perinatal stroke. Early detection can be accomplished by way of a comprehensive questionnaire and focused physical examination. The early detection of possible perinatal stroke will permit a referral to the proper professional and rapid intervention which will increase the likelihood of a positive outcome. More studies need to be done to reach a better understanding of the pathophysiology of perinatal strokes. Clinical guidelines also need to be established that will improve the prognosis for pediatric patients.

Key words:   perinatal stroke, infantile stroke, fetal stroke, presumed prenatal stroke, chiropractic, west syndrome, hemiparesis, cerebral palsy, delayed milestones, rehabilitation

From the FULL TEXT Article


Perinatal strokes are now estimated to occur in 1 in 4,000-5,000 newborn babies. [1-4] As a result of today’s new imaging technologies, the rate of diagnosis of this condition is on the rise. Because symptoms may not appear until a baby is between the ages of 4 to 6 months, a chiropractor may be the first health care professional that parents seek out when they encounter difficulties while breastfeeding or become aware of a delay in reaching expected developmental milestones. Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health.

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