 Summary of Fatal Pathology | Death Cases
HIGH NECK MANIPULATION There is a very fine line between near fatal pathology and actual death. Indeed in many cases the patient may remain comatose for months before dying or may be so impaired that though alive, their neurological disability renders them far beyond any hope whatsoever of normal life. A review of death cases and near death cases reveals the following pathological patterns going in general from those most likely to cause death to those that can cause death but are less likely to do so. Apart from the basic issue of thrombus formation and embolic pathology, neck manipulation also results in a cascade of pathologies such as hypotensive shock from dissection pathology in the extra-cranial portions of the vertebral arteries, hemorrhage, actual rupture, cerebral edema, herniation, top of the basilar artery syndrome, and extensive brain stem infarction. FIRST: INTRA-CRANIAL SUB-ARACHNOID HEMORRHAGE WITH EXTRA-CRANIAL VERTEBRAL ARTERY DISSECTION. LESIONS WHICH ARE BILATERAL ARE MOST DANGEROUS AS THEY REFLECT ON THE TYPE OF NECK MANIPULATION THAT WAS DONE. "Separation of extra-cranial and intra-cranial vertebral artery dissection is supported by differences in pathology, risk factors, clinical presentation and management. The plane of dissection in extra-cranial dissection is usually within the media and thus causes infarction, whereas in intra-cranial dissection, the hematoma is subintimal and may extend through the adventitia producing either an infarct or a subarachnoid hemorrhage". (Vertebral Artery Dissection- " Kuwait Medical Journal June 2001 R. Madhavan.) TWO: EXTENSIVE EXTRA-CRANIAL VERTEBRAL ARTERY DISSECTION WITH DISSECTION OF THE PLANE TO THE INTRA-CRANIAL VERTEBRAL ARTERIES BUT WITHOUT SUB-ARACHNOIDE HEMORRHAGE. Extensive extra-cranial dissection, especially in those cases in which the pathology descends distal to the axis is of greatest concern. THIRD: INTRA-CRANIAL SUB-ARACHNOID HEMORRHAGE WITH MINIMAL OR NO EXTRA-CRANIAL VERTEBRAL ARTERY DISSECTION. Although not commonly recognized, it is clear that upper neck manipulation can cause intra-cranial vertebral artery dissection. FOURTH: EXTRA-CRANIAL VERTEBRAL ARTERY RUPTURE. FIFTH: BILATERAL CAROTID ARTERY DISSECTION.  Back to top |
