The medial medullary infarction (Dejerine syndrome) following chiropractic neck manipulation

Jun Ichi Yokota, Yayoi Amakusa, Yutaka Tomita, Shinichi Takahashi

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

A-38-year-old man suddenly developed nausea, vomiting and vertigo during chiropractic neck manipulation. This was followed by right hemiplegia, right deep sensory disturbance and left hypoglossal nerve palsy, consistent with the medial medullary infarction (Dejerine syndrome). The MRI revealed infarction at left medial part of the medulla. The vertebral angiogram and MRA showed marked narrowing of the left vertebral artery. X-rays of the cervical spine showed no spondylosis, dislocation nor osteolysis of the odontoid process. The serological studies, including lupus anticoagulant, protein C, and protein S gave normal results. Although vascular accidents involving the brain stem after chiropractic neck manipulation have been reported since Pratt-Thomas and Berger, previous reports are still rare. In them lateral medullary infarction (Wallenberg syndrome) is probably the most common case. On the other hand, medial medullary syndrome (Dejerine syndrome) is absolutely rare. To our knowledge, the only one report has been made by Watanabe and his colleagues before our present case. The mechanism was suggested that rotation and tilting of the neck stretches and compresses the vertebral artery at the cervical joint causing injury to the vessel, with an intimal tearing, dissection, and pseudoaneurysm formation. Consequently, the present case may be caused by injury to the left vertebral artery with an intimal tearing during neck manipulation sufficient to cause dissection and subsequent infarction of the brain stem.

Original languageEnglish
Pages (from-to)121-125
Number of pages5
JournalBrain and Nerve
Volume55
Issue number2
Publication statusPublished - 2003 Feb 1
Externally publishedYes

Fingerprint

Chiropractic Manipulation
Infarction
Vertebral Artery
Neck
Tunica Intima
Dissection
Hypoglossal Nerve Diseases
Lateral Medullary Syndrome
Odontoid Process
Brain Stem Infarctions
Spondylosis
Lupus Coagulation Inhibitor
Osteolysis
Hemiplegia
Protein S
Vertigo
False Aneurysm
Wounds and Injuries
Protein C
Nausea

Keywords

  • Chiropractic cervical manipulation
  • Dejerine's syndrome
  • Magnetic resonance angiography(MRA)
  • Medial medullary infarction
  • Vertebral artery dissection

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Yokota, J. I., Amakusa, Y., Tomita, Y., & Takahashi, S. (2003). The medial medullary infarction (Dejerine syndrome) following chiropractic neck manipulation. Brain and Nerve, 55(2), 121-125.

The medial medullary infarction (Dejerine syndrome) following chiropractic neck manipulation. / Yokota, Jun Ichi; Amakusa, Yayoi; Tomita, Yutaka; Takahashi, Shinichi.

In: Brain and Nerve, Vol. 55, No. 2, 01.02.2003, p. 121-125.

Research output: Contribution to journalArticle

Yokota, JI, Amakusa, Y, Tomita, Y & Takahashi, S 2003, 'The medial medullary infarction (Dejerine syndrome) following chiropractic neck manipulation', Brain and Nerve, vol. 55, no. 2, pp. 121-125.
Yokota JI, Amakusa Y, Tomita Y, Takahashi S. The medial medullary infarction (Dejerine syndrome) following chiropractic neck manipulation. Brain and Nerve. 2003 Feb 1;55(2):121-125.
Yokota, Jun Ichi ; Amakusa, Yayoi ; Tomita, Yutaka ; Takahashi, Shinichi. / The medial medullary infarction (Dejerine syndrome) following chiropractic neck manipulation. In: Brain and Nerve. 2003 ; Vol. 55, No. 2. pp. 121-125.
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