Cervical Artery Dissection – A Medical Adverse Event?

Review written by: James Demetrious, DC, DABCO

In his article published in 2018 in the Open Access peer-reviewed journal, Chiropractic and Manual Therapy, Dr. James Demetrious offered a novel hypothesis of the causal relationship of fluoroquinolone (FQ) antibiotics and cervical artery dissections (CAD). With his awareness of previous FDA Blackbox warnings related to FQs associated connective tissue degradation, Dr. Demetrious posited the previously unconsidered possibility of arterial wall connective tissue degradation and a plausible mechanism of CAD.

PubMed searches revealed FQ related aortic dissections with no papers found related to cervical artery affection. While infection had been considered a risk factor for CAD, nobody previously considered that infection may not be the problem, but the antibiotic prescribed for the infection may represent the underlying causation. In his paper, Dr. Demetrious offered a plausible hypothesis that correlated FQs in the genesis of CAD. Notably, in 2019, authors Del Zotto and Pezzini confirmed the Demetrious FQ-CAD relationship having published a single-centre case-control study that has initially confirmed the formerly unknown risk factor.

A notable and distinguished chiropractic college suggested that the Demetrious revelation of FQ-CAD causation could be likened to a previously unknown, “invisible elephant in the room.” The ramifications of this iatragenic association is profound. Cassidy, Church, Chaibi and their associates have clearly defined that chiropractic care is not causative in the genesis of CAD. Patients seek chiropractic care with burgeoning CAD symptoms that require identification and emergent medical referral. Risk factors are vital to define patients with developing CAD. While additional research is necessary, the relationship of FQs in the genesis of CAD should be considered by all practitioners.