Wallenberg's syndrome following neck manipulation

We describe 4 patients ages 28 to 41 with lateral medullary infarction (Wallenberg's syndrome) following chiropractic neck manipulation. In 3 patients, angiography documented dissection of the extracranial 3rd segment of the vertebral artery near the atlantoaxial joint. The onset of neurologic symptoms following manipulation varied from immediate to 4 days. All had good recovery with minor residual deficits. Although the association between chiropractic neck manipulation and vertebral-basilar artery distribution infarction is well known, we emphasize its occurrence in young healthy individuals without commonly regarded predisposing factors.