• Dube D

• Adult
• Diagnosis, Differential
• Headache / diagnosis
• Intracranial Hypotension
• Open Access Document
• Stroke / diagnosis
• Subclavian Artery
• Vertebrobasilar Insufficiency

Background: Serious conditions such as stroke and conditions that mimic stroke may present to the chiropractic office and have the potential to be overlooked and subsequently mismanaged with examination primarily aimed to rule out the specific condition. The following two cases illustrate uncommon vascular conditions presenting at a chiropractic clinic and the clinical reasoning and diagnostic skills necessary to properly identify and manage such conditions.

Case Presentation: Two adult patients presented to a chiropractic clinic with severe headaches, vomiting, and orthostatic headache. In case 1, history and exam appeared to rule out stroke and chiropractic care including cervical manipulation was provided. However, a report of an orthostatic component to the headache was overlooked and the patient was later admitted to a hospital, diagnosed with spontaneous intracranial hypotension with sequela of subdural hemorrhage, and successfully treated with an epidural blood patch. Case 2 was immediately referred to the emergency department based on its similarities with case 1 and she was subsequently diagnosed with an intimal tear of the subclavian artery. After evaluation and clearance from a vascular specialist, normal chiropractic care including cervical manipulation commenced. Both patients reported complete recoveries at follow up.

Conclusions: Potentially serious conditions, including some which may mimic stroke, may present to a chiropractic clinic. These conditions may be missed if clinicians are not aware of their unique etiologies and fall into cognitive bias. Future research should explore the spectrum of emergency conditions presenting to chiropractic offices to guide future chiropractic education.

Author keywords: Headache, Subclavian Artery, Intracranial Hypotension, Vertebrobasilar insufficiency, Case Report, Stroke, Differential Diagnosis, Chiropractic Manipulation

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