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LETTER TO EDITOR
Year : 2011  |  Volume : 59  |  Issue : 2  |  Page : 303-304

Intracranial hemorrhage and cerebellar infarction caused by acupuncture


Department of Neurology,Seoul Medical Center, Korea

Date of Web Publication7-Apr-2011

Correspondence Address:
Jae-Hyeok Heo
Department of Neurology,Seoul Medical Center
Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.79160

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How to cite this article:
Heo JH, Bae MH, Lee SJ. Intracranial hemorrhage and cerebellar infarction caused by acupuncture. Neurol India 2011;59:303-4

How to cite this URL:
Heo JH, Bae MH, Lee SJ. Intracranial hemorrhage and cerebellar infarction caused by acupuncture. Neurol India [serial online] 2011 [cited 2019 Dec 15];59:303-4. Available from: http://www.neurologyindia.com/text.asp?2011/59/2/303/79160


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.
Figure 1: (a, arrow) Computed tomography of the brain showing a hemorrhage around the cerebellum and medulla. (b, arrow head) Diffusion MR image showing an acute infarction in the left medulla and left PICA territory

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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 More Details. 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 Top

1.Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, et al. Trends in alternative medicine use in the United States, 1990-1997: Results of a follow-up national survey. JAMA 1998;280:1569-75.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Lim ES, Seo MW, Oh SY, Yu SY, Woo SR, Jeong SY. A case of lateral medullary infarction associated with acupuncture procedure. Korean J Stroke 2004;6:175-7.  Back to cited text no. 2
    
3.White A. A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupunct Med 2004;22:122-33.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Choo DC, Yue G. Acute intracranial hemorrhage in the brain caused by acupuncture. Headache 2000;40:397-8.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Murata K, Nishio A, Nishikawa M, Ohinata Y, Sakaguchi M, Nishimura S. Subarachnoid hemorrhage and spinal root injury caused by acupuncture needle-case report. Neurol Med Chir (Tokyo) 1990;30:956-9.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Nelson E, Gertz SD, Rennels ML, Ducker TB, Blaumanis OR. Spinal cord injury. The role of vascular damage in the pathogenesis of central hemorrhagic necrosis. Arch Neurol 1977;34:332-3.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Tsukazaki Y, Inagaki T, Yamanouchi Y, Kawamoto K, Oka N. Traumatic subarachnoid hemorrhage associated with acupuncture. Headache 2008;48:1240-1.  Back to cited text no. 7
[PUBMED]  [FULLTEXT]  


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3 Intracranial hemorrhage and cerebellar infarction caused by acupuncture
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