Top Things to Know: Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Published: August 07, 2014

  1. Cervical artery dissection is an important cause of stroke in young and middle-aged patients.
  2. Cervical dissection accounts for less than 2% of all ischemic strokes, while cervical artery dissection accounts for 8-25% of all strokes in persons <45 years of age.
  3. Cervical dissection is most common in the high cervical spine region and can involve the carotid or vertebral arteries.
  4. Dissections can be either spontaneous or traumatic.
  5. The exact pathogenesis for spontaneous cervical dissections is unknown. There are several factors associated with cervical dissections including: major and minor cervical trauma, arterial hypertension, young age, migraine, moya moya disease, and infections, to name a few.
  6. Trauma can be severe (high speed velocity motor vehicle accidents) to subtle causes such as coughing, sneezing, or sporting activities (heavy lifting, golf, tennis and yoga).
  7. Cervical manipulative therapy with low or high amplitude thrust maneuver applied to the neck and its relationship to cervical dissection is evaluated in this paper.
  8. In North America, most cervical adjustments are done by chiropractors; however, other healthcare providers such as osteopaths, allopaths and physical therapists also practice cervical manipulation techniques.
  9. Treatment of cervical dissections include acute treatments such as endovascular therapy and thrombolysis. Prevention of stroke reoccurrence includes antithrombotic therapy.
  10. Patients should be informed of the potential association between cervical dissection and cervical manipulative therapy prior to manipulation of the cervical spine.


Biller J, Sacco RL, Albuquerque FC, Demaerschalk BM, Fayad P, Long PH, Noorollah LD, Panagos PD, Schievink WI, Schwartz NE, Shuaib A, Thaler DE, Tirschwell DL; on behalf of the American Heart Association Stroke Council. Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the American Heart Association/American Stroke Association [published online ahead of print August 7, 2014]. Stroke. doi: 10.1161/STR.0000000000000016.