Syncope, Dizziness, and Sensory Abnormalities After Upper Cervical (Atlas) Treatment: Mechanisms and Considerations

by Son PMR(Physical medicine &Rehabilitation ) & Chiropractic Clinic in Seoul

A patient with intractable cervical pain had visited multiple hospitals and eventually received upper cervical chiropractic manipulation at a Korean medicine clinic, after which they experienced syncope, severe dizziness to the point of difficulty standing, and abnormal sensation on the left side of the face. The patient was then referred to our clinic, where they were diagnosed with an upper cervical issue and have been improving with treatment.

Why did this patient experience these symptoms after receiving chiropractic manipulation?

Mechanisms Behind Syncope, Dizziness, and Sensory Abnormalities Following Upper Cervical (Atlas) Treatment

When a patient with intractable cervical pain experiences syncope, severe dizziness, and sensory abnormalities after a specific treatment, it is likely due to a combination of neurological and vascular factors.

1. Changes in Vertebral Artery (VA) Blood Flow

The first and second cervical vertebrae (C1 - Atlas, C2 - Axis) are critical structures through which the vertebral artery passes.

During chiropractic or manual therapy, excessive movement of the cervical spine may lead to temporary compression or alteration in vertebral artery blood flow.

Any disruption in blood supply to the brainstem and cerebellum can result in dizziness, impaired balance, and syncope.

2. Autonomic Nervous System (ANS) Response

The upper cervical spine plays a crucial role in regulating the autonomic nervous system.

The vagus nerve (parasympathetic) and the sympathetic nervous system are closely linked in this region.

Excessive manipulation of the cervical spine can trigger an autonomic response, leading to:

  • Hypotension (low blood pressure)
  • Bradycardia (slow heart rate)
  • Vasovagal syncope (a sudden drop in blood pressure causing fainting)

An overactive autonomic response can cause a significant drop in cerebral blood flow, resulting in severe dizziness and difficulty standing.

3. Nerve Compression and Sensory Abnormalities

The upper cervical spine, particularly C1 and C2, is closely associated with nerve function.

If there is nerve irritation or compression in this area, it may affect the trigeminal nerve, which is responsible for facial sensation.

This can lead to unilateral facial numbness, tingling, or dull sensation, as seen in this patient.

4. Pre-existing Neurological Sensitivities and Condition Aggravation

Patients with chronic cervical pain often have underlying upper cervical instability or heightened sensitivity in nerve and blood flow regulation.

If cervical manipulation causes tissue inflammation or subtle joint dysfunction, existing symptoms may worsen.

Conclusion

The symptoms experienced by this patient likely resulted from a combination of vertebral artery blood flow changes, autonomic nervous system reactions, and nerve compression.

Given the complexity of upper cervical treatment, precise diagnosis, extensive clinical experience, and meticulous technique are essential in chiropractic care.

Upper cervical chiropractic adjustments require an advanced level of expertise to ensure safety and effectiveness.


Consultation and Appointment Information

Son PMR & Chiropractic Clinic( 2nd floor, 229-1 Gucheonmyun-Ro, Gangdongu, Seoul, South Korea)
Contact: 02-482-8875 in Seoul( +82-2-482-8875)

chson@daum.net

Feel free to reach out for further consultation or to schedule an appointment.

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