Table 8.
Citation | Case Presentation | Treatment and Adverse Event reported |
---|---|---|
Morton, 2012 | A 31-yr old woman presented to the chiropractor at 16-wks GA with occipital HA. She has a 17-yr previous history of monthly, intermittent, bilateral occipital muscle tension HA that are unchanged with pregnancy. In addition, she had a history of migraine characterized by unilateral frontal HA, the last episode which had been 6-wks earlier. Patient was diagnosed with SLE 12 yrs earlier, complicated by renal involvement treated with azathioprine and prednisone, hypertension managed with labetalol and episodes of DVT and PE. She was heterozygous for prothrombin gene mutation but did not have lupus anticoagulant or anticardiolipin antibody. | Immediately following chiropractic treatment (not specified butbased on description, SMT was suggested), the subject reported severe right-sided anterior neck pain and developed ipsilateral Horner’s syndrome. MRI revealed dissection of the right internal carotid artery. It extended 5 cm distal to the carotid bulb to the horizontal intrapetrous segment. SLE flared up. 4 days after the onset of neurological symptoms, intrauterine fetal demise occurred. Tx: reported to ICU and treated with intravenous heparin and subsequently low-molecular weight heparin. Patient was placed on warfarin for 6 months. A follow-up MRI revealed a focal false aneurysm on the right internal carotid artery. One year later, Horner’s syndrome persists. |
cm – centimetre; DVT – deep vein thrombosis GA – gestational age; HA – headache; ICU – intensive care unit; MRI – magnetic resonance imaging; PE – pulmonary embolism; SLE – systemic lupus erythematosus; SMT – spinal manipulative therapy; Tx - treatment; yrs – years;