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Category: Case Studies
Date 6-may-1994
Case Title The Treatment of Presumptive Optic Nerve Ischemia by Spinal Manipulation
Author R. Frank Gorman, M.B.B.S., D.O.
Main Condition/ Disease  Visual Disturbance
Source Journal of Manipulative and Physiological Therapeutics (JMPT); Volume 18, No3, 172-77;(Mar/Apr 1995)
Abstract A case of a 62-year-old male with presumptive optic nerve ischemia, who presented with a one week history of monocular visual defect, headaches and neck strain. Vision improved dramatically following spinal manipulation as measured using static perimetry. The author’s conclusion is that cervical spine derangement produces microvascular spasm in the cerebral vasculature, including that of the eye.
Summary Gorman discusses a theory that entrapment of the vertebral arteries in the neck and irritation and distortion of these arteries leads to a negative influence on the flow in cerebral blood vessels, and states “an active stimulation of affected arteries constricts rather than reduces flow as a result of narrowing of the stem artery in the neck.” With this is mind he has found on numerous occasions that spinal manipulative therapy particularly of the cervical spine is responsible for improvements in visual loss and other visual anomalies. This case involves and elderly man who presented with a “blur sensation in left eye, daily left side headaches, tender left eye under palpation, strained neck and blood pressure issues.” Apparently prior to the symptoms staring he had equal vision in both eyes and after onset of symptoms his color perception in the affected eye was different. Ophthalmic tests revealed “no significant pathology” although static perimetry showed a scotoma. He has restricted range of motion of the c-spine and the atlas transverse processes were “tender to palpate”. Following the approach he has used in previous cases, Gorman carried out a combination of traction and manipulation to the cervical, thoracic and lumbar spine of the patient over a period of 9 days. The results were that “vision had improved considerably, tenderness to the eye had disappeared and palpation of the atlas and headache had disappeared”, further the scotoma had disappeared. Gorman suggests that “the tenderness of the atlas transverse processes is significant and an extremely valuable sign to the examiner of the possibility of cerebrovascular spasm”. This tenderness of the atlas transverse processes is a common sign in patients with derangement of the upper cervical spine. This tenderness Gorman and upper cervical chiropractors contend disappears when the upper cervical spine is adjusted. Gorman uses rotary techniques to adjust the c-spine whereas upper cervical chiropractors utilize precision non-rotary techniques. Without doubt, in my mind the cervical spine is the culprit in the majority of human conditions. It is now time that significant research funds were made available in order to verify upper cervical treatment as a valid approach to treating human suffering.
Keywords chiropractic manipulation, visual loss, optic nerve, ischemia

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