Annals of Indian Academy of Neurology
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CASE REPORT
Year : 2007  |  Volume : 10  |  Issue : 3  |  Page : 182-183
 

Neck massage induced dural sinus thrombosis


Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareily Road, Lucknow - 226014, UP, India

Correspondence Address:
Sunil Kumar
Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareily Road, Lucknow - 226 014, UP
India
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DOI: 10.4103/0972-2327.34800

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   Abstract 

Thrombosis of the intracranial dural sinuses and internal jugular veins may occur as a complication of head and neck infections, surgery, central venous access, local malignancy, polycythemia, hyperhomocysteinemia, neck massage and intravenous drug abuse. A high degree of clinical suspicion followed by adequate imaging is prerequisite to early diagnosis and management. We report a young man who had dural sinus thrombosis with jugular venous thrombosis following neck massage.


Keywords: Chiropractice, dural sinus thrombosis, neck massage


How to cite this article:
Verma A, Mohan S, Guleria S, Kumar S. Neck massage induced dural sinus thrombosis. Ann Indian Acad Neurol 2007;10:182-3

How to cite this URL:
Verma A, Mohan S, Guleria S, Kumar S. Neck massage induced dural sinus thrombosis. Ann Indian Acad Neurol [serial online] 2007 [cited 2014 Apr 23];10:182-3. Available from: http://www.annalsofian.org/text.asp?2007/10/3/182/34800



   Introduction Top


Thrombosis of the intracranial dural sinuses and internal jugular veins may occur as a complication of head and neck infections, surgery, central venous access, local malignancy, polycythemia, hyperhomocysteinemia, neck massage and intravenous drug abuse. It is also reported to occur spontaneously. Both are serious and potentially life-threatening conditions and can be associated with systemic sepsis, chylothorax, papilledema, airway edema and pulmonary embolism. A high degree of clinical suspicion followed by adequate imaging is prerequisite to early diagnosis and management. Neck trauma and neck manipulation are also important causes of carotid and vertebral artery dissections. We report a young man who had dural sinus thrombosis along with jugular venous thrombosis following an episode of neck massage, where the provisional clinical diagnosis considered was dissection of the vertebral artery. This report also highlights the importance of early imaging thus minimizing the possible complications leading to a prompt and uneventful recovery.


   Case Report Top


In October 2006 we came across a 25-year-old man, non-smoker, who had a neck and head massage performed by a barber for 30 minutes. The patient noticed pain and swelling of the right side of his neck and face following the massage. His symptoms increased during the initial 10h for which he took symptomatic medication from a local practitioner. He subsequently developed a severe, constant right parieto-occipital headache on the second day and presented to the emergency unit of our hospital. At presentation he also had weakness in right upper limb and blurring of vision. His past, personal and family histories were non-contributory. A neurological examination showed normal consciousness and orientation. Funduscopic examination revealed bilateral papilloedema without hemorrhage, but the remaining cranial nerves were intact. Laboratory analysis showed no evidence of any hypercoagulabilty of blood and the cerebrospinal fluid analysis was normal. A clinical diagnosis of vertebral artery dissection was considered and magnetic resonance imaging (MRI) scan of the brain, including Magnetic Resonance Angiograpgy (MRA) of head and cervical region and Magnetic Resonance Venography (MRV) was done using 1.5T scanner (GE Signa, Milwaukee, Wis, USA) using T1W, T2W, fluid attenuated inversion recovery (FLAIR) and diffusion weighted (DWI) sequences. There was an area of diffusion hyperintensity showing restriction on apparent diffusion coefficient (ADC) maps in the left parietal lobe and an area of increased signal intensity in the area of the right transverse sinus, right sigmoid sinus, right jugular bulb and the superior sagittal sinus [Figure - 1]. In addition, MRV of the intracranial venous sinuses and neck veins revealed thrombosis of the right Internal Jugular Vein (IJV), starting from the junction with the right subclavian vein. The right sigmoid sinus, the right transverse sinus and the superior sagittal sinus were not seen [Figure - 1]. The intra and extracranial carotid arteries and the vertebro-basilar system were normal. He was kept on intravenous anticoagulants for two days followed by which oral anticoagulation was given for another three days. The headache and papilloedema slowly improved over the next weeks, after which the patient was discharged. The patient was asymptomatic at the time of last outpatient attendance at three weeks of discharge.


   Discussion Top


Chiropractice is a popular modality of relaxation and alternative treatment. Thrombosis of IJV and intracranial venous sinuses due to above is rarely reported in the literature. [1] Neck massages progressing to IJV and cerebral venous sinus thrombosis have been reported in the past but the exact mechanism of thrombosis has not been mentioned. Venous stasis and vascular injury due to direct pressure/trauma during the massage might be implicated in the causation. [1] Other forms of trauma such as placement IJV catheters and neck tractions can also cause IJV thrombosis. [2] Although there are several reports of a relation between chiropractice manipulation and stroke, [3] trivial neck trauma and carotid/vertebral artery dissection, [4],[5] probability of potentially fatal intracranial venous sinus thrombosis caused by a leisurely undertaken neck massage needs to be emphasized. The take-home message is the need to be cautious while opting for any type of chiropractice.

 
   References Top

1.Wada Y, Yanagihara C, Nishimura Y. Internal jugular vein thrombosis associated with shiatsu massage of the neck. J Neurol Neurosurg Psychiatry 2005;76:142-3.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Larkey D, Williams CR, Fanning J, Hilgers RD, Graham DR, Fortin CJ. Fatal superior sagittal sinus thrombosis associated with internal jugular vein catheterization. Am J Obstet Gynecol 1993;169:1612-4.  Back to cited text no. 2  [PUBMED]  
3.Peters M, Bohl J, Th φmke F, Kallen KJ, Mahlzahn K, Wandel E, et al . Dissection of the internal carotid artery after chiropractic manipulation of the neck. Neurology 1995;45:2284-6.  Back to cited text no. 3    
4.Lloyd S. Carotid artery dissection following minimal postural trauma in a firefighter. Occup Med (Lond) 2004;54:430-1.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.DeBehnke DJ, Brady W. Vertebral artery dissection due to minor neck trauma. J Emerg Med 1994;12:27-31.  Back to cited text no. 5  [PUBMED]  


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    Abstract
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    Case Report
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