Complications of cervical manipulation: a case report of fatal brainstem infarct with review of the mechanisms and predisposing factors.

Medical and surgical complications of chiropractic manipulation occur infrequently in relation to the number of procedures performed. These complications include intracranial hemorrhage, spinal cord injuries, trauma to the carotid and vertebral arteries, and vertebral-basilar distribution infarction. This is a report of a case of vertebrobasilar infarction following chiropractic manipulation leading to a comatose state within 1 h following the manipulative procedure. This case report should alert the forensic pathologist to the possibility of cervical manipulation as a cause of acute brainstem infarction, and the mechanism and the predisposing factors to injury should be reviewed. The importance of careful autopsy technique and use of postmortem arteriographic techniques are emphasized.