Poorly Defined Mild Connective Tissue Disorders are a Pre-Existing Cause of Cervical Artery Dissection

Written by: James Demetrious, DC, DABCO

Diplomate, American Board of Chiropractic Orthopedists
Diplomate, International Academy of Neuromusculoskeletal Medicine

Defining Predispostions to Cervical Artery Dissection

In their recently published review article from the Mayo Clinic, Keser et al., provide insight into pre-existing predispositions of cervical artery dissection (CeAD). [1]

The authors report,

“Overall, the majority of the patients with CeAD have either subtle subclinical signs of underlying connective tissue disorder or are diagnosed with multisystemic connective tissue abnormalities that meet clinical, radiographic, and/or genetic criteria.” [1]

The authors reflect upon the incidence of systemic, yet poorly defined mild connective tissue disorders that are causative of CeAD:

  • Underlying collagen vascular disorders that meet diagnostic and genetic criteria are uncommonly found in CeADs (1–5% of spontaneous CeADs).
  • Isolated mild connective tissue abnormalities in skeletal, ocular, and skin systems (i.e., joint hypermobility or multiple dislocations, easy bruising, poor wound healing, or easy bruising) are frequently observed in patients with spontaneous CeAD (50–96%).
  • Close to 40% of patients with spontaneous CeAD were found to have fibromuscular dysplasia.

Wrongly Associated

Unfortunately, Keser et al. have associated cervical chiropractic neck manipulations as a common etiology of CeAD. This conclusion is unfounded and should not be perpetuated by objective researchers. Many previously published and highly powered studies have established no research basis for a causal relationship between CeAD and chiropractic spinal manipulation.

Let’s Focus on What is Most Important

CeAD events and permanent injury are extraordinarily rare. It is important that patients and their primary medical providers acknowledge and actively share information with chiropractors regarding the presence of heritable and acquired pre-existing predispositions.

These may include, but are not limited to defined connective tissue disorders, poorly defined connective tissue disorders, fibromuscular dysplasia, and the utilization of fluoroquinolone medications, etc.

In the clinical setting, insight into poorly defined mild connective tissue disorders may be derived from assessments of joint hypermobility utilizing the Beighton Scale, assessments of recurrent dislocations, easy bruising, poor wound, healing, etc.

Ascribing Blame Where It Belongs

Whenever a CeAD event occurs, clinicians must ascribe and apportion cause to predispositions of arterial susceptibility and other pre-existing causes of dissection and stroke.


Patients and their medical providers must provide vital clinical information to chiropractors to alert them of pre-existing CeAD and stroke susceptibility. In doing so, the extraordinarily difficult task of identifying burgeoning CeADs and stroke events may improve.


1.) Keser et al. Cervical Artery Dissections: Etiopathogenesis and Management Vascular Health and Risk Management. 2022:18 685–700.

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