J Neurol Surg Rep 2016; 77(04): e162-e167
DOI: 10.1055/s-0036-1597626
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Cerebral Hemorrhage Following Chiropractic Activator Treatment – Case Report and Review of Literature

Fred L. Cohen
1   Private Practice of Neurological Surgery, Palm Beach Gardens, Florida, United States
2   Gary Roberts and Associates, West Palm Beach, Florida, United States
› Author Affiliations
Further Information

Publication History

30 June 2016

07 November 2016

Publication Date:
19 December 2016 (online)


Background Despite widespread utilization of chiropractic treatment for various ailments, there is a paucity of documentation regarding intracerebral hemorrhage related to chiropractic trauma. Stroke has been reported from cervical manipulation, although with a suggested low incidence. Activator treatment, an instrument that produces a high-velocity, low-amplitude impact to the spine, is considered especially safe. There are no prior reports of intracerebral hemorrhage resulting from a chiropractic activator treatment.

Case Description A 75-year-old woman was admitted to the hospital with a history of headaches, visual difficulties on the right, and speech disturbance of relatively acute onset. CT scan showed a brain hemorrhage in an unusual location. Extensive evaluation was undertaken because this was thought to be a spontaneous event. No cause was found on imaging. Subsequent history revealed a chiropractic activator treatment applied directly to the junction of the back of her head and the upper cervical spine immediately prior to the onset of symptoms. Her clinical course is described.

Conclusions This appears to be the first report linking traumatic intracerebral hemorrhage with a chiropractic activator treatment. The use of this modality in an elderly population, with widespread utilization of anticoagulants and platelet inhibitors, is of potential concern.


The author, a practicing neurological surgeon and also a practicing attorney, has not had any personal experience litigating, representing, or defending any cases involving chiropractic complications of stroke or hemorrhage.