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Recurrent Stroke in a Child With Atlantoaxial Instability Following Chiropractic Manipulation

Ghanim, Majd T. MD*; Bergmann, Shayla MD*; Turner, Raymond D. MD; Eskandari, Ramin MD; Mahajerin, Arash MD

Journal of Pediatric Hematology/Oncology: July 12, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPH.0000000000001559
Clinical and Laboratory Observations: PDF Only

Pediatric stroke presents with a variety of signs and symptoms. Correct modality of imaging is essential in decreasing the time from symptom onset to appropriate management. Evaluation of pediatric stroke should include both blood work as well as imaging in a parallel rather than a sequential matter. We report a case of a child with a bow hunter’s stroke that was challenging to diagnose. This type of stroke happens when the vertebral artery is occluded at the atlantoaxial or subaxial level during neck rotation. This case demonstrates that workup of stroke should be comprehensive to include all mechanical and anatomic possibilities before investigating rarer hypercoagulable disorders.

*Division of Pediatric Hematology-Oncology

Department of Neurosciences, Medical University of South Carolina, Charleston, SC

Division of Hematology, Children’s Hospital of Orange County, Orange, CA

The authors declare no conflict of interest.

Reprints: Majd T. Ghanim, MD, Division of Pediatric Hematology-Oncology, Medical University of South Carolina, 135 Rutledge Avenue, MSC 561, Charleston, SC 29425 (e-mail:

Received January 8, 2019

Accepted June 9, 2019

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