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Summary of Fatal Pathology | Death Cases
Summary of Fatal Pathology
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.
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