Gradient echo image suggested blood clot in left PICA ( Figure 1D). But magnetic resonance (MR) imaging (MRI) revealed acute infarction in the left PICA territory ( Figure 1B and C). Brain computed tomography (CT) showed normal cerebellar parenchyma ( Figure 1A). Upon imaging, skull and cervical spine radiographs were normal. He initially denied any trauma, but remembered severe pain when he underwent a cervical chiropractic manipulation about two weeks prior. Routine laboratory tests of blood and electrolytes, were within normal ranges. He had no underlying disease and no medication use. Blood pressure was 150/80 mmHg, and pulse rate was 88 beats/min with normal sinus rhythm of electrocardiography. Finger to nose, heel to shin and rapid alternating movement test showed that cerebellar function was impaired on the left side, with intact function of the right side. At the time of admission, the patient showed alert consciousness, but neurological examinations showed the signs of cerebellar dysfunction. The possibility of VA dissection should be considered at least once in patients presenting with cerebellar dysfunctions with a recent history of chiropractic cervical manipulation.Ī 39-year-old man visited the emergency room with a dizziness and balance impairment that occurred 6 hours before. Three weeks later, he was discharged without any sequelae. He was treated with antiplatelet therapy. Angiography revealed complete occlusion of the left PICA and arterial dissection was shown in the extracranial portion of the VA. At the time of admission, brain computed tomography, magnetic resonance imaging, and angiography revealed an acute infarction in the left PICA territory and occlusion of the extracranial vertebral artery (VA V1/2 junction) as a result of the dissection of the VA. Two weeks ago, he was treated by a chiropractor for intermittent neck pain. A 39-year-old man visited the emergency room with signs of cerebellar dysfunction, presenting with a 6-hour history of vertigo and imbalance. We describe the case of a patient who had infarction of the posterior inferior cerebellar artery (PICA) after a chiropractic cervical manipulation.
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