Chiropractic, a discipline founded by D. D. Palmer in 1895, attributes illness to incorrect alignment of spine and seeks to treat diseases by manual manipulation of the spinal vertebrae [1
]. Approximately 10% of Americans consult chiropractors an average of seven to ten times per year, accounting for roughly 0.25 billion patients visit per year [1,5
]. Despite the large number of treatment sessions, complications following chiropractic treatment have been largely ignored. Askey [6
] reported six instances of hemiplegia immediately after spinal chiropractic massage, and Calverley and Millikan [7
] and Millikan [8
] described a total of seven patients who experienced contralateral paralysis after manipulation of the neck. Jumper and Horton [1
] reported a case of central retinal arterial occlusion followed manipulation of the neck by a chiropractor.
Central retinal arterial occlusion (CRAO) often results in profound, permanent loss of vision and is frequently associated with systemic vascular disease [9
]. The causes of CRAO include embolism, thrombosis, vasculitis, arterial spasm, arterial dissection, and hypertensive arteriolar necrosis [3
]. Of these, embolism is by far the most common cause, and the major source of emboli is a plaque in the carotid artery [10
]. The risk factors for arterial occlusive disease include hypertension, coronary artery disease, diabetes mellitus, hypercholesterolemia, and tobacco use [9-11
Here, we reported on a patient with central retinal artery occlusion following chiropractic neck manipulation. We suspect that cervical manipulation by the chiropractor dislodged an embolus from an artherosclerotic plaque in the right common carotid artery, which was obstructing the right internal carotid artery.
In conclusion, before undertaking neck manipulation, chiropractors and other medical personnel should inquire about a history cervical vascular disease, especially in older patients. The carotid artery should always be handled gingerly in patients with known or suspected artherosclerotic disease.