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Chiropractic Tied to Strokes in the Young

Study suggests telling doctor of any medical problems

FRIDAY, Feb. 8, 2002 (HealthDayNews) -- A trip to the chiropractor might relieve that pain in your neck, but it could lead to something much worse.

Chiropractic manipulations of the neck may account for as many as 20 percent of all ischemic strokes in Canadians under age 45, claims a new study. Researchers found wrenching movements of the upper spine can tear the arteries leading to the brain, leading to clots that could block blood flow to the organ and kill neurons.

The hotly disputed link between neck adjustments and stroke has loomed over the chiropractic table for decades.

In the latest study, Dr. Vadim Beletsky, formerly of the Sunnybrook & Women's College Health Sciences Center in Toronto, and his colleagues examined 98 men and women who'd suffered ischemic strokes -- those linked to blocked arteries -- after some form of mild to severe trauma. Thirty-eight of them had arterial tears resulting from neck manipulation, say the researchers, who presented their findings today at a meeting in San Antonio of the American Stroke Association.

Women were much more likely than men to suffer these strokes, the authors say. In addition, 16 percent of the patients had a previously diagnosed connective tissue disorder, such as Marfan Syndrome or fibromuscular dysplasia, known to weaken blood vessels.

Ultimately, the scientists say, neck manipulations may account for as many as 20 percent of the 750-odd ischemic strokes in Canadians under age 45, in whom the attacks are quite rare.

The Canadian researchers could not be reached for comment on their work. However, Dr. Larry Goldstein, director of the stroke center at Duke University Medical Center, calls the study "very limited."

It doesn't say, for example, how many people in Canada undergo chiropractic neck manipulations, so it's impossible to know the true risk of stroke related to the practice. Still, Goldstein adds, patients should know the dangers, great or small, of any medical procedure.

Dr. William Lauretti, a chiropractor in Maryland and his state's delegate to the American Chiropractic Association, acknowledges neck manipulations carry a slight risk of stroke. However, he adds, the risk is much smaller than that reported by the Canadian researchers. A better figure, Lauretti says, is probably one per 1 million treatments -- but perhaps as few as one per 8 million.

If that's the case, Lauretti says, chiropractic neck manipulations aren't much different from conventional therapies.

"If a person has a sore neck and goes to any sort of health care, there's always going to be a risk" of harm no matter how conservative the treatment, he says. After all, he says, thousands of Americans die each year from gastric bleeding associated with nonsteroidal anti-inflammatory drugs (NSAIDs), which many people take regularly for pain.

What To Do

Dr. Casilda Balmaceda, a Columbia University neurologist, says patients shouldn't be deterred from seeking chiropractic treatment. However, they should avoid having their neck manipulated. "Chiropractics have a lot of other things they can offer," she says.

In addition, Lauretti says patients should tell their chiropractor about any pre-existing conditions they have, such as a genetic disorder, that might put them at risk of vessel problems.

For more on strokes, which affect as many as 750,000 Americans each year, try the American Stroke Association. For more on chiropractic, visit the American Chiropractic Association.

SOURCES: Interviews with Larry Goldstein, M.D., director, stroke center, Duke University Medical Center, Durham, N.C.; Casilda Balmaceda, M.D., assistant professor, neurology, Columbia University College of Physicians and Surgeons, New York City; William Lauretti, D.C., Bethesda, Md., Feb. 8, 2002, American Stroke Association meeting abstract
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