Fellow-Cerebrovascular & Endovascular Barrow Neurological Institute Phoenix, Arizona, United States
Introduction: The risk of ischemic stroke after carotid artery dissection due to neck manipulation (e.g. chiropractic manipulation) has been well described in the literature. However, causing a stroke with a low-risk procedure such as a duplex ultrasound examination has not been described.
Methods: We present the case of a 63-year-old male patient, who had an episode of unspecific chest pain / syncope for which he underwent a negative work-up at an outside hospital except for a moderate, no hemodynamically significant 50-69% right cervical carotid stenosis deemed unrelated to his symptoms. He was discharged home after a doppler neck examination with a plan for outpatient follow-up and was initiated on ASA daily. The next day he was found dysarthric and hemiparetic and was taken to an outside emergency department and established to have a tandem stroke with complete cervical carotid occlusion and right middle cerebral artery (M1) occlusion (NIHSS 12, ASPECTS 5).
Results: He was transferred to our institution and underwent urgent mechanical thrombectomy with a successful result (TICI 2b) and carotid stenting.
Conclusion : This case illustrates an association between a recent neck manipulation (neck ultrasound examination) followed by an acute carotid occlusion. Although it remains unclear if the examination is fully responsible for triggering a plaque dislodgment and carotid occlusion, the doppler ultrasound examination suggested only moderate stenosis without unstable plaque.
