Chiropractic, Golf, Yoga Can Cause Carotid Dissection

LAS VEGAS -- One of the common causes of carotid dissection is chiropractic manipulation. It occurs in about 1 in every 20,000 treatments, Stephen R. Ramee, M.D., said at a meeting on vascular interventions sponsored by Medical Media Communications.

Other causes include activities such as yoga and golf.

"We've actually seen [it in] golfers who were encouraged to swing hard, said Dr. Ramee, an interventional cardiologist who practices in New Orleans.

Carotid dissection occurs at a rate of 3 cases per 100,000 persons per year. But while it is rare, it is the second most common cause of stroke in persons under 45 years, about 20% of stroke in younger persons.

Carotid dissections usually occur at a characteristic location, about 1 inch above the carotid bifurcation. However, angiography is not considered diagnostic because an occluded vessel can have the same appearance as dissections. Dr. Ramee said he uses CT in the cases he sees in order to be able to visualize the vessel layers.

The most common presenting signs are intracranial pain, Horner syndrome, and transient ischemic attack. Up to 25% of patients describe a pulsatile tinnitus.

Because most persons can perfuse their brain adequately with a single carotid, the treatment is medical, either anticoagulant or antiplatelet therapy for 3-6 months.

Most cases will heal with this treatment. Stenosis resolves on its own 90% of the time and occlusions resolve two-thirds of the time. Stroke risk is low as long as the patient is asymptomatic.

Endovascular procedure, usually stenting with or without coils, is reserved for patients whose dissections do not resolve with medical treatment and who continue to have symptoms of cerebral ischemia.