 |
| About Bioline | All Journals | Testimonials | Membership | News |
|
||||||
|
||||||
Neurology India, Vol. 59, No. 2, March-April, 2011, pp. 303-304 Letter to Editor Intracranial hemorrhage and cerebellar infarction caused by acupuncture Jae-Hyeok Heo, Myoung-Hoon Bae, Su-Ji Lee Department of Neurology,Seoul Medical Center, Korea Correspondence Address: Jae-Hyeok Heo, Department of Neurology,Seoul Medical Center, Korea, seoulneurology@gmail.com Code Number: ni11085 PMID: 21483144 DOI: 10.4103/0028-3886.79160 Sir, Acupuncture is a common and popular procedure practiced with varied indications in China, Japan, and Korea. [1] Recently, acupuncture has been viewed as a major complementary therapy in Europe and the United States. [2] However, serious adverse events such as pneumothorax, hepatitis B infection, septicemia, and spinal cord injury have been reported, in addition to other mild adverse effects. [3] In particular, acupuncture in the posterior cervical area can rarely cause vertebral artery dissection or brain stem injury. [2] Here, we report a rare case with concurrent intracranial hemorrhage and cerebellar infarction following acupuncture. A 65-year-old man visited hospital with acute posterior neck pain and vertigo of 3 days duration. These symptoms developed suddenly during acupuncture in the posterior neck area by an unauthorized acupuncturist. The headache was very severe associated with nausea and vomiting and the neck pain had radiated to the suboccipital area. His blood pressure was 170/80 mmHg and other vital signs were stable. Neurologic examination revealed mild dysarthria and truncal ataxia. Neck stiffness was also noted. Brain computed tomography (CT) revealed intracranial hemorrhage around medulla and cerebellum [Figure - 1]a. Diffusion-weighted imaging showed an acute infarction in the left medulla and left posterior inferior cerebellar artery (PICA) territory [Figure - 1]b. Although 3-D CT angiography performed 5 days after the symptom onset showed normal vertebral artery, we suspected left vertebral artery injury caused by acupuncture. We chose conservative management strategy and the patient recovered gradually over 1 month. Our patient presented with intracranial hemorrhage and infarction in the left medulla and left cerebella following acupuncture. We suspect that a deep penetrating acupuncture needle in the posterior neck might have injured the vertebral artery. Lim et al.[2] reported a patient with lateral medullary infarction following acupuncture and suggested acupuncture-related vasospasm of the vertebral artery as the possible cause. Earlier, a patient with intracranial hemorrhage following acupuncture had been reported by Choo et al.,[4] and in their patient, the acupuncture needle might have been inserted between occipital bone and the atlas. Murata et al.[5] reported a patient with subarachnoid hemorrhage that was caused by an acupuncture needle buried in the posterior neck between C1 and C2 about 30 years before the onset. [5] The co-occurrence of infarction and hemorrhage is a very unusual presentation. In our patient, direct vascular injury might have been caused by the acupuncture needle, which in turn could have caused the intracranial hemorrhage. The possible mechanism for infarction of the medulla and cerebellum might be either due to vasospasm or thrombosis of the vertebral artery. [6] Though CT angiography showed no luminal narrowing of the left vertebral artery, transient vasospasm is still a possibility in our patient. For the past several decades, many complications following acupuncture have been reported, and some of these complications have been fatal or life threatening. [3],[7] We feel that the acupuncturists and patients undergoing acupuncture should be aware of the potential lethal acupuncture-related complications. References
Copyright 2011 - Neurology India The following images related to this document are available:Photo images[ni11085f1.jpg] |
| |||||||||
![[Figure - 1]](/showimage?ni/photo/ni11085f1.jpg){kind=link}