Letter to the Editor

The Letter to the Editor discusses the crucial issue of recognizing and responding to potential strokes in chiropractic practice, particularly focusing on vertebral artery dissection (VAD). The authors affirm that while chiropractors are not expected to diagnose strokes, they must refer patients for urgent evaluation if symptoms diverge from typical musculoskeletal presentations. The article acknowledges that VAD is rare and most patients recover well when referred appropriately. Although there is no convincing evidence that cervical spinal manipulation (CSM) directly causes VAD, the authors emphasize the plausible risk that performing CSM in the presence of an existing, underlying dissection could worsen the condition or precipitate an immediate thromboembolic stroke. Given that vascular screening tests for VAD lack reliability, clinical reasoning and vigilance in history-taking are deemed essential preventative measures. The letter strongly urges all chiropractors to become familiar with published research detailing structured risk-benefit clinical assessment strategies designed to exclude VAD prior to performing CSM. Adopting this framework is crucial for recognizing atypical presentations, preventing avoidable strokes, and reducing significant patient harm and malpractice liability exposure.