The ‘American Heart Association News’ recently reported the case of a 33-year-old woman who suffered a stroke after consulting a chiropractor. I take the liberty of reproducing sections of this article:
Kate Adamson liked exercising so much, her goal was to become a fitness trainer. She grew up in New Zealand playing golf and later, living in California, she worked out often while raising her two young daughters. Although she was healthy and ate well, she had occasional migraines. At age 33, they were getting worse and more frequent. One week, she had the worst headache of her life. It went on for days. She wasn’t sleeping well and got up early to take a shower. She felt a wave of dizziness. Her left side seemed to collapse. Adamson made her way down to the edge of the tub to rest. She was able to return to bed, where she woke up her husband, Steven Klugman. “I need help now,” she said.
Her next memory was seeing paramedics rushing into the house while her 3-year-old daughter, Stephanie, was in the arms of a neighbor. Rachel, her other daughter, then 18 months old, was still asleep. When she woke up in the hospital, Adamson found herself surrounded by doctors. Klugman was by her side. She could see them, hear them and understand them. But she could not move or react.
Doctors told Klugman that his wife had experienced a massive brain stem stroke. It was later thought to be related to neck manipulations she had received from a chiropractor for the migraines. The stroke resulted in what’s known as locked-in syndrome, a disorder of the nervous system. She was paralyzed except for the muscles that control eye movement. Adamson realized she could answer yes-or-no questions by blinking her eyes.
Klugman was told that Adamson had a very minimal chance of recovery. She was put on a ventilator to breathe, given nutrition through a feeding tube, and had to use a catheter. She learned to coordinate eye movements to an alphabet chart. This enabled her to make short sentences. “Am I going to die?” she asked one of her doctors. “No, we’re going to get you into rehab,” he said.
Adamson stayed in the ICU on life support for 70 days before being transferred to an acute rehabilitation facility. She could barely move a finger, but that small bit of progress gave her hope. In rehab, she slowly started to regain use of her right side; her left side remained paralyzed. Therapists taught her to swallow and to speak. She had to relearn to blow her nose, use the toilet and tie her shoes.
She was particularly fond of a social worker named Amy who would incorporate therapy exercises into visits with her children, such as bubble blowing to help her breathing. Amy, who Adamson became friends with, also helped the children adjust to seeing their mother in a wheelchair.
Adamson changed her dream job from fitness trainer to hospital social worker. She left rehab three and a half months later, still in a wheelchair but able to breathe, eat and use the toilet on her own. She continued outpatient rehab for another year. She assumed her left side would improve as her right side did. But it remained paralyzed. She would need to use a brace on her left leg to walk and couldn’t use her left arm and hand. Still, two years after the stroke, which happened in 1995, Adamson was able to drive with a few equipment modifications…
In 2018, Adamson reached another milestone. She graduated with a master’s degree in social work; she’d started college in 2011 at age 49. “It wasn’t easy going to school. I just had to take it a day at a time, a semester at a time,” she said. “The stroke has taught me I can walk through anything.” …
Now 60, she works with renal transplant and pulmonary patients, helping coordinate their services and care with the rest of the medical team at Vanderbilt University Medical Center. “Knowing that you’re making a difference in somebody’s life is very satisfying. It takes me back to when I was a patient – I’m always looking at how I would want to be treated,” she said. “I’ve really come full circle.”
Adamson has adapted to doing things one-handed in a two-handed world, such as cooking and tying her shoes. She also walks with a cane. To stay in shape, she works with a trainer doing functional exercises and strength training. She has a special glove that pulls her left hand into a fist, allowing her to use a rowing machine and stationary bike….
Adamson is especially determined when it comes to helping her patients. “I work really hard to be an example to them, to show that we are all capable of going through difficult life challenges while still maintaining a positive attitude and making a difference in the world.”
________________________
What can we learn from this story?
Mainly two things, in my view:
- We probably should avoid chiropractors and certainly not allow them to manipulate our necks. I know, chiros will say that the case proves nothing. I agree, it does not prove anything, but the mere suspicion that the lock-in syndrome was caused by a stroke that, in turn, was due to upper spinal manipulation plus the plethora of cases where causality is much clearer are, I think, enough to issue that caution.
- Having been in rehab medicine for much of my early career, I feel it is good to occasionally point out how important this sector often neglected part of healthcare can be. Rehab medicine has been a sensible form of multidisciplinary, integrative healthcare long before the enthusiasts of so-called alternative medicine jumped on the integrative bandwagon.
23 Responses to Locked-in syndrome after chiropractic and partial recovery after rehabilitation
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As a medical student, I did an internship with a general practitioner 34 years ago. After a strenuous semester, I had muscular back pain. Without warning, he straightened me. This was the beginning of my dislike of faith healers.
Ties into my research interest.
“The relative risk of ischaemic stroke is doubled in people with MA compared with migraine-free individuals.”
https://jnnp.bmj.com/content/91/6/593
“Several mechanisms that may cause ischemic stroke in migraine have been described, of which CSD-induced endothelial dysfunction is the primary pathophysiology of ischemic stroke in migraine.”
https://ejnpn.springeropen.com/articles/10.1186/s41983-022-00562-x
“Additional findings suggest that women with a history of migraine have an increased sensitivity to physiologic fluctuations in estradiol levels. Several studies suggest that migraines are associated with menstruation.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948327/
‘research interest’?
without a single publication of research?
Strange question.
Regardless, due to the response, and lack of it, from MDs/trauma centers, I think the best approach is to try and publish in Medical Hypotheses.
https://www.sciencedirect.com/journal/medical-hypotheses
are you saying you published in that journal?
i am saying that it appears that the best approach to address this topic is to first publish in MH.
so, you haven’t published anything in MH or any other journal!
Is that what I wrote?
no, that’s what I know.
It is interesting that I shared an interest in publishing on a topic that could end up being a relative/absolute contraindication to cSMT and your response has nothing to do with the topic. So be it.
blowhard [count noun]:
• a person who likes to talk about how important they are
— Cambridge Dictionary
• an arrogantly and pompously boastful or opinionated person
synonyms: braggart; windbag
— Merriam-Webster
Put up or shut up: If you say someone should put up or shut up, you mean that they should either take action in order to do what they have been talking about, or stop talking about it.
— Cambridge Dictionary
I don’t blame them for not wanting to work with quacks.
Wilk vs AMA lives on
DC, Given the information you quote, I understand that sensible chiropractors blankly refuse to manipulate necks on persons, esp. women, with a history of migraine, particularly during an ongoing episode of migraine. Right?
And not to mention those other Chiropractic victims who, much like my wife Sandra Nette, NEVER had any issues whatsoever with migraines, past or present. In fact, Sandy never seems to be bothered by even mild headaches, something I wish I could say for myself!
Come to think of it, the only thing that gives me a major migraine, is accepting the fact that Chiropractors are STILL twisting people necks DESPITE the overwhelming evidence of harm and serious risk.
Thanks for a relevant question.
I haven’t seen any research specific to that question.
This survey found
“The clinical management plans of chiropractors with a high migraine caseload more often included advice on diet/nutrition (p < 0.001), smoking/drugs/alcohol (p < 0.001), physical activity (p = 0.005), occupational health and safety (p < 0.001), pain counselling (p < 0.001), nutritional supplements (p < 0.001) and medications (including for pain/inflammation) (p < 0.001) than those chiropractors who less often managed patients with migraine.”
and also
“The treatment techniques/methods more often used by chiropractors with a high migraine caseload were high velocity, low amplitude (HVLA) spinal manipulation (p = 0.023), drop-piece techniques (p = 0.015), sacro-occipital techniques (p < 0.001), instrument adjusting (p = 0.001), biophysics (p = 0.040), applied kinesiology (p = 0.001), functional neurology (p < 0.001), dry needling (p = 0.006), heat/cryotherapy (p = 0.002), orthotics (p < 0.001) and extremity joint manipulation methods (p < 0.001).”
If they typically abstain from HVLA in these active cases I don’t know. Some probably do, some probably don’t.
https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/s12906-017-2026-3
This survey indicates that those with migraines seek chiropractic care more often than those without migraines.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3627391/
Re my interest, it may be those with menstrual migraines may be at a higher risk of a serious AE with cSMT than those with other etiologies of migraines.
“This survey indicates that those with migraines seek chiropractic care more often than those without migraines.”
Ignoring the terrible wording, the same applies to each of the 10 CAM modalities listed in Table 2:
Prevalence of Complementary and Alternative Medicine (CAM) Therapiesa Use in the Previous 12 Months.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3627391/table/T2/?report=objectonly
Also:
@Språkdoktorn Olle Kjellin
Whenever EE posts something about chiropractic, DC puts up smoke and mirrors to deflect the conversation. In this case it’s the migranes, not the chiropractors fault. The other day his argument was “but physios do it too” : https://edzardernst.com/2023/06/spinal-manipulations-for-lumbar-radicular-syndrome/#comment-146446 or he mentions the stack of research proposals sitting on his desk: https://edzardernst.com/2023/06/adverse-events-associated-of-spinal-manipulation/#comment-146401 because MDs are refusing to help him with his research. If all else fails, OPOIDS!!! That pretty much sums up most of the tricks in his bag.
By the way, sensible chiropractor is an oxymoron.
SOK. Another interesting finding, sounds familiar to VAD.
“Other relevant associations with SCAD include a history of hypertension, migraine headache, extreme exertion or emotional stress, and pregnancy or postpartum status.1-3 Furthermore, SCAD is a common causative mechanism of pregnancy-associated myocardial infarction.1,2 The association of SCAD with female sex and pregnancy suggests that sex hormones may contribute to its pathophysiology.”
https://jamanetwork.com/journals/jamacardiology/article-abstract/2730292
“Spontaneous coronary dissection is a rare event most often seen in young women with few risk factors. It may occur at any time of low levels or rapidly declining levels of circulating estrogens such as pregnancy or during a menstrual cycle.”
https://www.hmpgloballearningnetwork.com/site/jic/article/7330
SOK: another interesting finding…
“In a large, heterogeneous cohort, we found that cervical dissection was associated with an approximately 4-fold increased risk of subsequent aortic dissection.”
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.055274
Indeed, it does sound like yet just another smoke screen. The bottom line is it seems there is a lot of focus on all the “many” reasons why a VAD WOULD occur. Yet there appear to be Chiropractors who continue to twist necks as some kind of cure-all for just about everything.
That said, with so many “possible risk factors’ playing into final negative outcomes involving rapid upper neck manipulations, why continue with this practice (Neck Adjustment) at all?
Explain to me again the definition of insanity. I submit we have been on this Hamster wheel for far too long.
If the Chiropractors won’t stop twisting necks on their own accord despite repeated catastrophic strokes and an array of other similar devastating injuries, and only the Chiropractors are left to govern themselves…who then can enforce the immediate stoppage of rapid upper neck manipulations?
As I understand it, there is no policy in place instructing patients to have complete physicals prior to Chiropractic appointments. Show me differently please.
I am still awaiting the Great Awakening.
Well, sadly this one hit way too close to home, given our own unfortunate experience at the hands of a Chiropractor. Prior to Sandys trauma I had never heard of this Locked-In Syndrome “condition”.
I’m always relieved when I hear of someone who has gone through the horrors of Locked in Syndrome and defied all the odds. Despite her obvious challenges Kate pushed through! I am extremely relieved that this victim has made such a miraculous recovery.
Our story: After many years of multiple surgeries, my wife at 56 now has regained much as well.
Although unable to no longer drive she is great at pointing out what wrong turn I have taken and is quick to point out how I always manage to miss the shortest route.
Her peripheral vision never did return but thankfully with time many of the “other” medical accessories were eventually disconnected.
She can now swallow but we have to be very careful as choking is just something we have to accept on a routine basis as there is still throat paralyses. The complete replacement of her jaw joints has definitely helped things somewhat.
Sandy can now do her own wheelchair transfers…a major achievement but she never did re-gain her balance. The Doctors who years ago rebuilt her legs and “remedied” the effects of long-term stroke symptoms, correcting and improving curvatures and feet inversions, were successful.
I do miss the past memories of hearing Sandys sweet voice, but am so very grateful she has regained any vocal use at all!
Piano has long since been sold but we keep her golf clubs tucked away in the basement…just in case of a miracle! Sandy has emphatically told me not to sell them. Maybe there will be a nice 18 hole course in Heaven.
Fast forward to today and fifteen years of surgeries and subsequent recoveries, and needless to say these have all taken their toll on her broken little body.
As a senior land administrator working in the Oil and Gas Industry, along with her Legal background, she does miss working and being busy. Finding things that stimulate her senses today are now, as her husband, one of my biggest challenges.
Some days frankly she just wishes she were dead. Some days she reflects on her past decisions to “maintain health” and beats herself up for ever seeing a Chiropractor. It’s very hard not to look back and have regrets.
There are” good” days of course but these seem fewer and far between. And as I grow older my ability to help Sandy with the everyday things also are proving to be more and more difficult. Financially I do not know how anyone manages after such catastrophic life changing events, but we know there are many who have it much worse than us.
We have a part-time caregiver which fortunately allows me to continue working on a small scale, but at my age I know my workdays are numbered.
I am thankful for sites and blogs like this that continue to enlighten the masses to the dangers of upper neck manipulations.
We press on.
Dave & Sandy Nette
thank you