"TO BE HONEST, I DISCOVERED A CAROTID BRUIT IN A PATIENT DURING MY FIRST YEAR OF PRACTICE.  IT WAS A COMPLETELY JARRING EXPERIENCE."

Patients everywhere are beginning to question the necessity of a chiropractic manipulation...HERE'S WHAT YOU NEED TO KNOW.

It's all over the news: Model Katie May passed away at the age of 34.  Here is just 1 article of many describing the situation:
 http://www.nydailynews.com/entertainment/gossip/model-katie-death-fall-photo-shoot-article-1.2521755

This type of story tends to circulate around the media every time a similar situation occurs in our field.  Unfortunately, it perpetuates the general public's fear of chiropractors.  There is NO DIRECT CAUSE-EFFECT RELATIONSHIP BETWEEN STROKES AND CHIROPRACTIC MANIPULATIONS.  HOWEVER, IT IS A VERY REAL RISK FACTOR THAT ALL CLINICIANS AS WELL AS THEIR PATIENTS NEED TO BE AWARE OF.

The trauma she experienced on a photo shoot that led her to believe she was experiencing a pinched nerve, was likely the injury that resulted in a tearing of her carotid artery.  Check out the image below for the anatomical and pathological significance of this condition. 

Essentially, a tear occurs within the artery itself, leading to a blood clot (which is your body's attempt to repair the damaged structure).  This blood clot, or fragments, may then become dislodged and travel downstream to important structures in the face and brain.  Once the clot (or fragments) reach a small enough blood vessel that is impassable, nutrient deprivation occurs to that area.  Certain signs and symptoms should be evident at this point.  Unfortunately, prior to this stage of the condition, signs and symptoms may be relatively vague...such as neck pain.
Picture
http://www.riversideonline.com/source/images/image_popup/ans7_carotid_artery-dissection.jpg
The American Stroke Association estimates that 10% of strokes occur in people under the age of 45, like May.  Most of you probably associate stroke with the elderly population but this is a dangerous misconception.  Now, although I am obviously a chiropractor, I am not going to blindly support the chiropractor involved in this case.  WHY?  Because there are necessary questions and procedures to medically rule in or rule out stroke as a diagnosis.

FAST is the acronym regularly advertised by the American Stroke Association now and is a great tool for the general public's recognition of a medical emergency.

Face
Arm
Speech
Time

More specifically, look for:
Face-drooping or face numbness
Arm weakness or arm numbess
Speech difficulty or slurred speech
Time to call 9-1-1 as these symptoms indicate a medical emergency.

HOWEVER...when a patient presents to a doctors office with vague neck pain induced by trauma that is not improving, a more thorough clinical investigation should follow.  While nothing is 100% accurate, there is a significant likelihood that if your neck pain resulted from an arterial dissection, the following will assist the clinician in determining the cause.  If a carotid dissection is expected, the patient should have a doppler ultrasound of the carotid artery to determine the severity of the clot or plaque build-up.

So here are the steps I take in my office to rule out the possibility of stroke.  
Ask the 5 Ds And 3 Ns in the office for anyone with neck pain or headaches as well as auscultation of carotid arteries to detect a bruit (an abnormal whooshing sound).
5 Ds
Diplopia (double vision)
Dysphagia (trouble swallowing)
Dysarthria (trouble speaking)
Dizziness (vertigo-like symptoms)
Drop attacks (spontaneous falls)

Ataxia (loss of controlled bodily movements)

3 Ns
Numbness (abnormal sensations)
Nystagmus (repetitive, uncontrolled eye movements)
Nausea (uneasiness of stomach)

Auscultation of carotid artery below:
Picture
https://i.ytimg.com/vi/aTub9RP7Uuk/hqdefault.jpg
TO BE HONEST, I DISCOVERED A CAROTID BRUIT IN A PATIENT DURING MY FIRST YEAR OF PRACTICE.  IT WAS A COMPLETELY JARRING EXPERIENCE.  I am in no way trying to "toot my own horn".  It is necessary for those of you reading this to know that I do take the medically necessary steps to determine the cause of your pain and will absolutely refer to other medical providers if indicated.

There are risk factors associated with any and every medical procedure...from a basic blood draw TO chiropractic manipulations TO medications TO surgical interventions.

I hope that you realize that the media has portrayed this inappropriate connection between chiropractors and stroke.  If you seek care from ANY MEDICAL PROFESSIONAL: ASK ABOUT POSSIBLE RISKS ASSOCIATED WITH THE PROCEDURE.

As always, I look value feedback and look forward to hearing from you.  
Be Blessed!
-Dr. K
 


Comments

Ryan
02/19/2016 9:15am

Hey Dr. K,

Awesome post. This is definitely a confusing issue, and this was a great explanation. I loved the clinical pearl, and will definitely be utilizing it in my practice once I graduate. Keep up the good work.

Reply
02/19/2016 9:49am

Ryan, thanks for the support and I'm glad you gained some knowledge from this. Never stop learning. Be well!
-Dr. K

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    Erik Korzen DC is a chiropractic physician and educator.  He is passionate about re-defining the chiropractic profession and is somewhat of an "Anatomy Geek".

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