(HealthDay News) — Evidence suggests there may be an association between cervical manipulative therapy and cervical artery dissections (CDs), according to an American Heart Association/ American Stroke Association scientific statement published online August 7 in Stroke.

José Biller, MD, from the Loyola University Chicago Stritch School of Medicine, and colleagues reviewed the current evidence on the diagnosis and management of CDs and their association with cervical manipulative therapy.

The researchers note that patients with CD may present with unilateral headaches, posterior cervical pain, or cerebral or retinal ischemia. CD diagnosis is mainly based on history, physical examination, and targeted ancillary examinations. Mechanical forces may result in intimal injuries of the vertebral arteries and internal carotid arteries, leading to CD, although the role of trivial trauma is unclear. Among patients with CD, disability levels vary, with many having good outcomes although serious neurologic sequelae are observed. No evidence-based guidelines are available for best CD management; antiplatelet and anticoagulant therapies are used for prevention of local thrombus and secondary embolism. An epidemiological association has been suggested between CD, especially vertebral artery dissection, and cervical manipulation therapy based on case-control and other studies. It is unclear whether this association is due to unrecognized CD in these patients or cervical manipulation therapy-induced trauma.

“Although a cause-and-effect relationship between these therapies and CD has not been established and the risk is probably low, CD can result in serious neurological injury,” Biller said in a statement. “Patients should be informed of this association before undergoing neck manipulation.”

Two authors disclosed providing expert testimony in malpractice cases.

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