Causal analysis of vertebral artery dissection and fatal stroke following chiropractic cervical spine manipulation

Q3 Medicine

Forensic Science International: Reports Pub Date : 2024-12-15 DOI:10.1016/j.fsir.2024.100400

Steven P. Brown

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Abstract

A 34-year-old female suffered a fatal stroke 7.5 h after cervical spine manipulation (CSM) performed by a chiropractic physician. Imaging noted vertebral artery dissection (VAD), basilar artery occlusion, and thromboembolic stroke. The medical examiner opined that CSM caused the VAD which embolized to cause the fatal stroke. However, causation of VAD by CSM is not supported by the research.

We utilized an intuitive approach to causation analysis to determine the cause of the VAD and the stroke. Causation of the VAD and the stroke by CSM could not be established as more likely than not. The malpractice case was settled by bringing allegations of misdiagnosis and failure to diagnose and refer the VAD to medical emergency.

We conclude that in the absence of convincing evidence that CSM could cause VAD, forensic professionals should consider VAD as a presenting symptom prior to CSM in such cases. Adherence to the standard of care for the chiropractic profession with attention to differential diagnosis could prevent such cases.

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颈椎推拿后椎动脉夹层及致死性脑卒中的原因分析

一名34岁女性在由一名脊医进行颈椎推拿（CSM）后发生7.5 h的致命中风。影像学显示椎动脉夹层（VAD）、基底动脉闭塞和血栓栓塞性中风。法医认为是CSM引起的VAD栓塞导致了致命的中风。然而，CSM与VAD的因果关系并没有得到研究的支持。我们利用直观的方法进行因果分析，以确定VAD和中风的原因。VAD与CSM卒中之间的因果关系尚不能确定。这起玩忽职守案通过对误诊和未能诊断并将VAD转介到医疗紧急情况的指控得到解决。我们的结论是，在缺乏令人信服的证据表明CSM可能导致VAD的情况下，法医专业人员应该在此类病例中将VAD视为CSM之前的表现症状。坚持脊骨按摩专业的护理标准，注意鉴别诊断，可以防止这种情况发生。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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