A controversial neck-manipulation treatment associated with a rare type of stroke appears to have led to the death of Playboy model Katie May, according to the Los Angeles coroner’s department.

The 34-year-old May – who also modeled for GQ and Sports Illustrated – died Feb. 4 of a stroke after being treated by a chiropractor. Although the full coroner’s report is pending, Los Angeles Assistant Chief Coroner Ed Winter cited “neck manipulation by [a] chiropractor” in May’s death certificate as the cause of the injury that led to her death, according to media reports.

According to a 2014 scientific statement from the American Heart Association/American Stroke Association, neck manipulation has been associated with cervical dissection, an arterial tear that can lead to stroke.

“While the incidence is low and causality is difficult to prove, cervical manipulation therapy plays a role in a number of dissections,” said José Biller, M.D., the statement’s lead author and professor and chair of neurology at the Loyola University Chicago Stritch School of Medicine.

“Cervical dissection is an important cause of stroke in young and middle-age patients. Patients and practitioners of cervical manipulation therapy have to have a high index of suspicion and vigilance,” he said.

May – whom Playboy dubbed “The Queen of Snapchat” for frequently posting images of herself – had tweeted about her neck pain several days before her death: “Pinched a nerve in my neck on a photoshoot and got adjusted this morning. It really hurts!” May reportedly went back for a second chiropractic treatment before her death.

Biller – who wasn’t involved in May’s treatment and didn’t comment on her case specifically – said that a wide range of neck injuries can, in rare instances, put you at risk for a stroke.

“It might be a severe, clear-cut trauma or more of a trigger-type of injury like twisting your neck abruptly while skiing or backing up your car or playing ping-pong. Many of the so-called ‘spontaneous dissections’ are triggered by a minor trauma that might be forgotten or may seem inconsequential to the patient.”

Whether it’s a minor injury or a major trauma, an arterial dissection can result in an ischemic stroke, Biller said. “It could trigger a formation of a blood clot, and if that clot becomes loose and migrates and blocks a vessel, that might cause a stroke.”

The AHA/ASA urges patients to seek emergency medical care if they develop neurological symptoms after neck manipulation, including:

  • headache or pain in the back of the neck;
  • arm weakness;
  • dizziness/vertigo;
  • double vision;
  • unsteadiness when walking;
  • slurred speech;
  • nausea and vomiting; or
  • jerky eye movements.

Biller stressed that doctors and patients should discuss risks and complications before neck-manipulation therapy begins.

“There can be some very serious consequences,” he said. “Cervical manipulation therapy can aggravate the beginning of a dissection, or it may be the mechanism causing the dissection. Both the patient and those who perform cervical-manipulation therapy should be cognizant of the facts.”

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