Blind Pig Finds Acorn. Chiropractor Diagnoses Dissection

Blind Pig Finds Acorn. Chiropractor Diagnoses Dissection

Regular readers of this blog and Science-Based Medicine are aware of two issues.

The preponderance of information suggests that chiropractic neck manipulation is associated with vertebral artery dissection. The data is so compelling that the American Heart Association/American Stroke Association had a scientific statement that says in part

Although current biomechanical evidence is insufficient to establish the claim that CMT causes CD, clinical reports suggest that mechanical forces play a role in a considerable number of CDs and most population controlled studies have found an association between CMT and VAD stroke in young patients. Although the incidence of CMT-associated CD in patients who have previously received CMT is not well established, and probably low, practitioners should strongly consider the possibility of CD as a presenting symptom, and patients should be informed of the statistical association between CD and CMT prior to undergoing manipulation of the cervical spine.

Regular readers also know that Chiropractors deny the risk. Which is no surprise since pseudo-medical providers never alter therapy to increase patient safety or because of lack of efficacy.

What is the take home message for Chiropractors in response to the AHA paper?

Based on information presented in the AHA paper as well as new research showing how often the diagnosis of stroke is missed in the ER, the real take-home message is that all health care providers attending to people with headaches or neck pain should be vigilant for neurological problems that could be the early signs of a stroke.

Which is why I had to laugh when I read Vertebral artery dissection in evolution found during chiropractic examination.

A patient with a history of migraine presented with transient visual loss to the ER, they blame it on migraine. 2 days later she goes to a chiropractor with neck pain pain and the chiropractor thinks about vertebral artery dissection and gets an MRI to confirm the diagnosis and

No manipulation was performed.

That must have taken remarkable self-control. I'll give the chiropractor props for being on their toes and making the diagnosis. VAD can be a difficult to diagnose. As a rule in health care, we are most attuned to the processes and complications that we cause due to our interventions.

But it is a case of zero medical interest, with nothing unique or interesting. I diagnosed a case of lung cancer on the basis of clubbing that was missed by the primary doc. Fun for me, but hardly worth a case report. So why was it published?

This was published in BMJ Case Reports which

has a unique business model whereby users (whether authors and/or readers) become Fellows.

Individuals pay an annual fellowship fee of £152; US$297; €206 (plus applicable VAT). During your 12 month fellowship period you can submit as many cases as you like, access all the published material, and re-use any published material for personal use and teaching without further permission.

So for for $297 you can publish any insipid case that suits your fancy. And this was a case as bland as water.

The only reason such a banal case is published that I can imagine is propaganda. Look. We chiropractors don't cause dissection, we diagnose it after real doctors miss the diagnosis.  It supports the ACA talking points nicely, although I have no knowledge that the two are related. Probably just coincidence.

What I would like to see is a case report by a DC: Vertebral artery dissection due to chiropractic manipulation. That will never happen as denial and a motivated reasoning will always trump patient safety.

Points of Interest 11/19/2015
Points of Interest 11/17/2015

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