Q: Can chiropractic neck manipulation cause a stroke? To give us a background on this issue we invited Professor Charlotte Leboeuf-Yde to discuss two articles recently published in Chiropractic & Manual Therapies that fall on either side of this debate. They found that 2/3 of patients were improved at 3 and 12 months, but how many untreated patients would also have improved by then? It seems plausible that gentle mobilization techniques would be less likely to cause a vertebral artery tear than high velocity low amplitude (HVLA) manipulation techniques. Perle and other chiropractors cite a 2008 Canadian study that found that of those who had strokes following neck manipulation, most had already been having symptoms suggestive of a stroke. Not much specialist believe my theory, but i am 100% sure this was the cause of my stroke. In 2010, stroke cost about $73.7 billion in both direct and indirect costs in the U.S. alone. It was a prospective study, but there was no control group. Four years ago i had a stroke caused by a Vertebral Artery Dissection. 3. Â© 2017 BioMed Central Ltd unless otherwise stated. As this type of injury can occur spontaneously or after activities involving certain neck positions, a major question rears its head at regular intervals, namely: âIs the CVA truly the result of the cervical manipulation or is it only âan accident waiting to happen?â This question is based on the notion that people with a (painful) cervical dissection are likely to seek care, and if manipulation is performed in such patients, a clot may dislodge itself to complete the pathology but â on the other hand – it may have happened already, Â completely on its own, regardless of the manipulation. study that showed VAD was more common after SMT, 74-79% of patients with non-specific neck pain typically recover in a year, patients with cervical radiculopathy improve over time, upper cervical chiropractic is nonsensical, Detecting Consciousness in the Vegetative, Chiropractors didn’t do it: it was other practitioners who were less well trained who did the suspect manipulations. 6,7 As for any true therapy, spinal manipulation is not without risk. The minutes after i can’t remember. A 2012 study published in the International Journal Of Clinical Practice “Assessing the risk of stroke from neck manipulation: a systematic review” concluded: Conclusive evidence is lacking for a strong association between neck manipulation and stroke, but is also absent for no association. But itâs a possibility to know. Another study found a benefit of exercise combined with manipulation/mobilization but also of exercise alone. Jane Racey Gleeson. Those are valid criticisms. A: Maybe. Neck Manipulation Linked to Stroke Risk The American Heart Association (AHA), in a new statement published in its journal Stroke, warns about the risk of stroke for patients receiving neck manipulation therapy. The safety of cervical spinal manipulation (i.e., manipulation of the vertebrae in the neck) for neck pain has been questioned because previous observational research found an association between visits to a health care practitioner and subsequent vertebrobasilar stroke (VBS). View the latest posts on the On Medicine homepage. The findings were published in the Neurology medical journal. Obviously we can discount the mythical subluxation in forming any such rationale, but with other treatments available, what should be the criteria by which a responsible practitioner would even suggest neck manipulation? Nothing else has been shown to reduce the risk of stroke after radiation to the head, neck or chest, she said. In some cases, that results in a blood clot which can travel to the brain, resulting in stroke. They argue that the Cassidy-analyses therefore were polluted by this misclassification, whereas the other team (Murphy et al) vehemently disagrees. He says it “concluded that patients present to either a chiropractor or GP with neck pain because of their stroke already being present.” The Cassidy study does not say what he thinks it says. If this stroke is caused by a clot and the clot is small or lodges itself in an area where there is additional blood-supply, the symptoms may be minor or short-lasting. Four large studies have established an association between neck manipulation and stroke in patients 45 and younger, although the evidence does not prove that the practice can â¦ What is the incidence of stroke in the general population? She is a chiropractor with extensive research experience within the epidemiology of back pain and various clinical aspects of chiropractic. One team (Paulus &Thaler) argues that the Cassidy case-control study is faulty, because vertebro-basilar stroke in general was not separated from stroke specifically caused by vertebral artery dissections, the presumed culprit in cervical spinal manipulation. Here, doctors explain how this might have happened. ). Upon which the manipulator adds a quick, low force and shallow movement, resulting in the spinal joint giving way in an âadditionalâ step, which is within its anatomical boundaries but usually outside the natural movement pattern. Upper cervical (NUCCA) practitioners only treat the top vertebra of the neck in every patient. In order to make a rational decision on risk versus benefit of chiropractic neck manipulation, three questions would seem to me to need answers. A 2004 Cochrane systematic review found that mobilization and manipulation were not beneficial alone, but were equally beneficial when used in conjunction with exercise. What is most worrisome is that some of those patients got neck manipulations for symptoms in other parts of the body unrelated to the neck, or even for no symptoms at all (maintenance adjustments as a preventive health measure). By Shereen Lehman, Reuters Health. Tuchin argues that it seems impossible for a thrombus to instantly form, dislodge, and travel to the cerebral cortex to cause a stroke within seconds of receiving SMT; but I would argue that if an existing clot were dislodged, symptoms would be almost immediate. Facial pain with numbness is the most common neurologic consequence. Can I Have a Stroke Because of Chiropractic Manipulation? A number of case control studies have suggested an association between chiropractic neck manipulation and cervical artery dissection (CAD), but a causal relationship has never been established. The author is Peter Tuchin, a senior lecturer in chiropractic at Macquarie University in Australia, and a known apologist for chiropractic. " Neck manipulation as a cause of stroke.." Stroke, 12(1), p. 1. NEW YORK (Reuters Health) - - Blood vessel â¦ 74-79% of patients with non-specific neck pain typically recover in a year, and even patients with cervical radiculopathy improve over time with only conservative treatments such as use of a collar and physical therapy. Neck manipulation can damage arteries and cause stroke in young people, claim Canadian researchers Alternatives like gentle mobilization, physical therapy, and exercise are better choices. 56% of patients reported adverse events and 13% reported these to be severe. For most practitioners using spinal manipulation after this report, the question was answered; the stroke patientâs early symptoms made him consult and the full-blown stroke would follow, regardless of the treatment. Is the CVA truly the result of the cervical manipulation or is it only âan accident waiting to happen? 12 . Despite the uncertainty, they thought the association was strong enough to recommend informed consent be obtained and patients be warned that neck manipulation “may” increase the risk of a rare type of stroke. Risk is higher for people who have connective tissue disorders (Marfan's syndrome, for example). Two pairs of blood vessels in the neck (the cervical arteries) carry blood to the brain. Part of Springer Nature. (No supporting evidence, and a good reason to avoid neck manipulation. She is, for example, one of the first researchers to have studied normal and adverse reactions of spinal manipulation in large practice based study populations. Figures; References; Related; Details; Cited By. For those aged <â45âyears, a strong measured association was found within 1âweek of the stroke, with four cases (3.6%) compared with four controls (0.9%) [OR crude =â3.94 (95% CIâ=â0.99â15.78), (nonâparametric bootstrap 95% CIâ=â0.64â46.28)]; Often it’s promoted for migraine, tension headaches or other conditions where the link to any anatomy in the neck is speculative at best. Some argue, for example, that cervical manipulation does not have enough benefits to justify this potential risk. Back to top. Children get neck manipulations for problems like ear infections. Chiropractic neck manipulation may increase the risk of stroke, advises WebMD. In the absence of proven benefit, even a hypothetical risk is unacceptable. Previous. An Australian Cricketer, Philip Hughes, aged 25, died two days after being struck on the top of the neck by a ball during a domestic match leading to the vertebral artery dissection prompting significant bleeding to the brain. Indeed, other causes of stroke can never be completely ruled out in any individual case, since vertebral artery dissection (VAD) is known to occur after any hyperextension of the neck, such as painting a ceiling or getting a shampoo at the beauty parlor, and it can even occur spontaneously without hyperextension. ), SMT didn’t cause it: it was due to one of those other things that can cause VAD. This may be the cause of 8 to 25 percent of strokes in patients under the age of 45. The vertebral arteries supply the brainstem and cerebellum at the base of the brain. Arterial dissections may occur after serious trauma, after quite mundane activities which involve prolonged or extreme neck positions, and possibly also spontaneously. See Mark Crislip’s critique of that study. He places considerable emphasis on the Cassidy study. Tuchin’s study begins by critiquing published reports of chiropractic strokes, objecting that details are not furnished and other causes of stroke are not ruled out. If youâre in the habit of having your neck adjusted by a chiropractor, Michigan Medicine neurologist Mollie McDermott, M.D., wants to share â¦ Delayed effects cloud the issue: in some of the â¦ 1. In the present issue of Chiropractic & Manual Therapies, two teams are debating that old question, this time based on the issue of misclassification of cases. ), Patients went to a chiropractor because they were already having symptoms of a stroke. Indeed, a previous study* by Cassidy et al showed that vertebro-basilar stroke was equally common in people who had consulted a medical practitioner as in those consulting a chiropractor. Could people achieve remission of type 2 diabetes without needing to lose weight? Â If it closes off the arterial system, serious and perhaps irreversible damage may occur within the brain. Thrust manipulation is an effective method for the treatment of headaches (cervicogenic or neck generated 1 and migraine 2), post traumatic 3 and chronic neck pain, 4 mid-back pain, 5 and lower back pain. The symptoms of a vertebral artery stroke are headache and focal neurological signs. According to Paulus & Thaler, this would potentially result in a dilution of ârealâ manipulative-related strokes among all other causes of stroke that are much more common. The author argues for continued use of this treatment pending an answer to the first, but that is not a decision that can be made in isolation from the other two. A 2007 study purported to show that the benefits outweighed the risks for patients undergoing chiropractic care for neck pain. And other factors should be considered, like the many “smoking gun” cases and whether there is any conclusive evidence of benefit to set against the possibility of risk. The symptoms of vertebral artery dissection may begin soon after receiving a neck manipulation. National Center for Complementary and Integrative Health, Steven P. Novella, MD – Founder and Executive Editor, David H. Gorski, MD, PhD – Managing Editor, The sad saga of an Amish girl with a curable cancer whose parents are refusing chemotherapy in favor of “natural healing”, Assessing the risk of stroke from neck manipulation: a systematic review. Though only 36 percent of the neurologists responded to the survey, "56 strokes were reported to be related to cervical chiropractic maniplation." Did a lot of research myself and believe that tis dissection was caused by a maneuver in which my spinal segment is placed in an extreme âendâ position. Symptoms of Stroke Nausea, vomiting, dizziness, weakness, slurred speech, sudden numbness on one side of the body, vision problems, severe headache. The short answer is that you can have a stroke while doing anything, including before, during or immediately after Chiropractic treatment. Still, it's one of the most common causes of stroke in people under the age of 50. Professor Wand and colleagues state that although manipulation of the cervical spine is a common treatment option for muscular neck pain, it carries the risk of causing a bleed of the vertebral artery, which would result in a vertebrobasilar stroke. While fairly rare overall, it is a common cause of stroke in young adults. Nevertheless, it may also happen, although exceedingly rarely, that real adverse events occur after spinal manipulation of the neck, such as damage to the wall of the artery that passes through the neck to the brain (arterial dissection), which may result in a stroke, with various potentially catastrophic symptoms following. And although headache usually precedes the neurologic signs, many patients don’t seek care until the neurologic signs have developed; and I would guess that those signs would be more likely to send them to the ER than to the chiropractor. Symptoms may develop immediately or just hours after a chiropractic manipulation. ... but serious neurologic injury can occur. Many of these patients will receive spinal manipulation and most will probably feel some immediate relief. This study showed that mobilization is less likely to cause adverse reactions in general. Mark Crislip has explained Hill’s criteria here. Chiropractic manipulation of neck may cause stroke. Most MDs and many chiropractors agree that it can, but some chiropractors disagree. Helpful, trusted answers from doctors: Dr. Simon on chiropractic neck adjustment stroke: It is possible to get a vessel injury from neck manipulation which can lead to a stroke. In the meantime, practitioners and patients have to make a decision, similarly to judging risk in other walks of life, such as, should I take the plane or stay at home? Chiropractors frequently manipulate the neck. Vascular accidents, including strokes and deaths, after upper spinal manipulation are a well-recognised problem ( e. g. 1,2). Does case misclassification threaten the validity of studies investigating the relationship between neck manipulation and vertebral artery dissection stroke? His explanation is confusing, since he includes comments that are not relevant to the criterion being considered, and he presents the same arguments under more than one criterion. In other cases, such as Katie Mayâs, the symptoms may linger for days or weeks. Vertebral dissection can occur as a result of physical trauma to the neck including chiropractic and osteopathic manipulation of neck. Getting into this extreme ‘end’ position was caused by sleeping on 2 pillows in tummy position and moving fast from this extreme to position to the other side to mute my alarm clock. There is an argument on whether spinal manipulation carries enough benefits to justify the potential risk of causing a stroke and whether the manipulation itself is the cause of the stroke. Delayed effects cloud the issue: in some of the reported cases, stroke occurred as long as 15 days after spinal manipulation therapy (SMT), postulating a clot that temporarily sealed the tear and later broke loose. Biller noted that cervical artery dissections often occur with blunt, penetrating types of injuries, and also with neck manipulations. Twenty-six patients developed their symptoms within 48 hours after a manipulation, including five patients who got symptoms at the time of manipulation and four who developed them within the â¦ *The study by Cassidy et al is from a subscription journal and the full article may not be accessible to you. And that really is what’s going on here. What is the objective risk? Background: Strokes, typically involving vertebral artery dissection, can follow cervical spinal manipulative therapy, and these types of stroke occur rarely. Also, a tear can cause bleeding between the layers of the arterial wall, creating a hematoma that rapidly expands to directly occlude the artery. May, who was 34 at the time of her death, died of a "vertebral artery dissection." But the risk, if it exists, is very low. She received her BA and MD from the University of Washington, did her internship in the Air Force (the second female ever to do so), and was the first female graduate of the Air Force family practice residency at Eglin Air Force Base. Although the group could not confirm whether neck manipulation causes stroke or not, they cite the need to inform patients of the potential risk before receiving such therapy. World Diabetes Day 2020: nursing education and care. Without an international collaboration involving prospective cases this seems an almost impossible task. A 2010 Cochrane systematic review found that mobilization was as effective as manipulation. I can imagine the outcry of the medical profession wanted to use a drug linked to fatal strokes on the basis that they think the drug is really good, albeit they have mainly anecdotal evidence for this, and that nobody can absolutely prove that it kills people. No. A majority of patients consulting a chiropractor for any reason will be subjected to neck manipulation. Clinical reports suggest that mechanical forces play a role in a considerable number of CDs, and population controlled studies have found an association of unclear etiology between CMT and VAD stroke in young patients. We have not had the kind of definitive controlled trials to prove that the neck manipulation is causing the dissection because it is possible that the neck pain itself was caused by the dissection which occurred before the CMT. Can neck manipulation cause strokes? Shares. We keep returning to the subject not because it is a common problem (it isn’t), but because it is such a devastating one, and because the general public is still not aware of the risk. What alternative treatments exist? (No evidence to support that claim. Since neck manipulation has not been demonstrated to be effective, even the suspicion of a risk is reason enough to reject the treatment. The final word is clearly not yet pronounced on this issue and both these two teams agree that research has to address various methodological challenges to obtain a trustable answer. In the case of chiropractic manipulation of the neck, there is no objectively proven benefit, and other treatments exist for which there is not even a theoretical risk of vertebral artery dissection. New evidence suggests that this is not without risks, in some cases of catastrophic outcomes. I also believe that it is better to be more cautious and not go to a chiropractor because that could just make the situation worse. Charlotte Leboeuf-Yde, DC,MPH,PhD, is professor in Clinical Biomechanics at the University of Southern Denmark and works at the French-European Institute of Chiropractic in Paris. Chiropractic adjustments may cause a tear in the artery. In short, there is no evidence-based reason to prefer manipulation techniques to mobilization with exercise. Note that that neck pain is not even on the list. By continuing to use this website, you agree to our Terms and Conditions, Community Guidelines, Privacy statement and Cookies policy. Until these cases are compiled, investigated, and explained otherwise, it is reasonable to assume a cause/effect relationship. Next. From this risk set, controls were sampled with replacement to create a set of 4 matched controls for each case.1516 There are plenty of reported cases where patients suddenly developed stroke symptoms when a practitioner manipulated their neck. During the stretch of one year, about half of all adults would have felt some type of neck pain, and some of these will seek treatment. While the existing evidence is not definitive, it supports the strong probability of a causal relationship, especially considering the many “smoking gun” cases. They can occur after âa sudden movement that can hyperextend or rotate the neck that may happen with certain sporting activities, with whiplash or â¦ Source: American Heart Association (AHA), Heart Disease and Stroke Statistics - 2010 Update. Those are valid criticisms. Not surprisingly, we have here the added dimension of professional political boundaries; the âno-to-manipulationâ and the âyes-to-manipulationâ-teams, representing two different professional groups. 6 Min Read. In 2008 she published her memoirs, Women Aren't Supposed to Fly. Hill’s criteria were applied to the chiropractic subluxation construct with disastrous results for the basic premise of chiropractic: No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention. And while everyone agrees that SMT is contraindicated in the presence of a VAD, chiropractors have demonstrated their inability to predict which patients are at risk. Regardless of popular appeal this leaves the subluxation construct in the realm of unsupported speculation. It seems to me on the face of it that the chiropractic profession should be issuing clear guidance not to twist the neck unless there is a compelling reason to do so. Chiropractic and Stroke: Association or Causation? Other common neurologic signs are dizziness or vertigo, dysarthria or hoarseness, loss of pain and temperature sensation in the trunk and limbs, loss of taste, hiccups, nausea and vomiting, problems with vision, difficulty swallowing, and unilateral hearing loss. Yes, Does case misclassification threaten the validity of studies investigating the relationship between neck manipulation and vertebral artery dissection stroke? (But there are plenty of reports involving chiropractors. According to the University of Michigan, signs of a stroke caused by vertebral artery dissection can include: Slurred speech; Sensory loss; Weakness of the arm or leg on one side of the body ; Vertigo â¦ Chiropractic Neck Manipulation and Stroke: Whatâs the Risk? The whole premise of upper cervical chiropractic is nonsensical. Exploring issues and controversies in the relationship between science and medicine. Biller is a neurologist with Loyola University and was the author recently of a joint statement on stroke risk and neck manipulation that was published by the American Heart Assn. The survey asked 177 Calif. neurologists about the number of patients they treated in the past two years who had suffered a stroke within 24 hours of cervical chiropractic manipulation. Nevertheless, without an international collaboration involving prospective cases this seems an almost impossible task, particularly in view of the rarity of the condition; problems in capturing all cases (going from the reversible to the permanent injuries); the likely large anatomical and physiological variations between individuals; and the daunting task of obtaining relevant and precise descriptions of treatments from a multitude of practitioners. A population-based nested case-control design was used.15 Using the date of a caseâs VBA as the reference date, we created a risk set of all members of the population matching the case on date of birth and sex and simultaneously eligible to be a case as of the reference date. During a long career as an Air Force physician, she held various positions from flight surgeon to DBMS (Director of Base Medical Services) and did everything from delivering babies to taking the controls of a B-52. But he tries to make his case with fallacious arguments and questionable claims rather than with scientific data, and the whole article smacks of apologetics for chiropractic. If that clot breaks off, another condition called a vertebrobasilar artery (VBA) stroke can occur which can leave you seriously mentally ... the motions of your neck that occur during neck manipulation can put the 2 vertebral arteries that run through your vertebral column at higher risk for injury. What is the objective benefit? Does spinal manipulation of the neck cause strokes or is it just an âaccident waiting to happenâ? Cervical spine manipulation is therefore only one among many potential causes. Indeed, other causes of stroke can never be completely ruled out in any individual case, since vertebral artery dissection (VAD) is known to occur after any hyperextension of the neck, such as painting a ceiling or getting a shampoo at the beauty parlor, and it can even occur spontaneously without hyperextension. Tuchin correctly concludes that the evidence that SMT causes strokes is not definitive and is not supported by all of Hill’s criteria of causation. Stroke is a leading cause of serious long-term disability, with an estimated 5.4 million stroke survivors currently alive today. A tear in the lining of one of these vessels, called a cervical artery dissection, is rare, occurring in just one to three in 100,000 people per year. But if it closes off the arterial system, serious and perhaps irreversible damage may occur within the brain. Specifically, in relation to spinal manipulation, we are mainly dealing with a vertebral artery dissection with either local symptoms from the surrounding tissues or symptoms further away (vertebrobasilar stroke). VBS is an uncommon type of stroke involving the arteries that supply blood to the back of the brain. The idea that patients were already experiencing symptoms of a stroke was not a conclusion of the study, but merely a hypothesis of the authors that was not supported by their data. I agree with him that the existing evidence is inadequate to conclusively determine causality, but I think it supports a high probability of causality, and the alternate explanations he offers to exonerate chiropractors are questionable. Spinal manipulation can be described as a manual maneuver in which a spinal segment is placed in an extreme âendâ position. They can occur after âa sudden movement that can hyperextend or rotate the neck that may happen with certain sporting activities, with whiplash or violent coughing or vomiting movements, or with neck manipulation therapy,â Biller said. A study of stroke cases led by University of California San Francisco (UCSF) neurologists, indicates that chiropractic manipulation of the neck can tear the vertebral artery leading to a stroke. #BlackInCardioWeek: How it started, what happened, and what is to come, A Winning Poem from the BMC Cancer Awareness Poetry Competition 2019 by Shari Rhodes, Mapping travel time to health facilities allows countries to prepare for new outbreaks, Three questions answered by the winners of the BMC ‘Cancer Awarenessâ poetry competition. As the CVA is a rare occurrence and, as CVAs associated with spinal manipulation are even scarcer, it is a very difficult phenomenon to study, meaning that mainly very large case-control studies are suitable. August 28, 2017 7:00 AM . The concern is that neck manipulationâ in which the chiropractor âalignsâ the spine by abruptly rotating the headâmay stretch and tear the vertebrobasilar artery in the upper neck, causing vertebral artery dissection (VAD). A new study in the same journal, “Chiropractic and Stroke: Association or Causation?” applies Hill’s criteria of causation to the evidence and concludes that causality has not been determined. Tuchin addresses each of Hill’s criteria. This lack of supportive evidence suggests the subluxation construct has no valid clinical applicability. The subject has been covered on SBM before: here, here, here, here, here, here, here, here, and here. Neck manipulation may be associated with stroke. After reading this blog, I am more cautious regarding neck pain and muscle pain in general. Short answer is that you can have a stroke 2007 study purported to show that the outweighed. The CVA truly the result of the brain study purported to show that the benefits outweighed the for. Were published in the artery will probably feel some immediate relief this study showed that was... May not be accessible to you are n't Supposed to Fly does case misclassification the... Catastrophic outcomes posts on the list not even clear that neck pain chiropractic manipulation there! Have happened 34 at the time of her death, died of a is! That study risks, in some cases, such as Katie Mayâs, symptoms! 2008 she published her memoirs, Women are n't Supposed to Fly going on here, i am more regarding... This blog, i am 100 % sure this was the cause of stroke occur rarely validity studies! Arteries that supply blood to the brain critique of that study the on Medicine homepage headache and focal signs! Of vertebral artery dissection stroke medical specialty, whereas the how long after neck manipulation can a stroke occur team ( Murphy et al ) vehemently.... `` vertebral artery dissection stroke ) as when you crack the knuckles how long after neck manipulation can a stroke occur fingers. Waiting to happen to neck manipulation may increase the risk results in a negative sense ) as when you the. Years of cancer evolution: time to understand its clinical implications 2020 nursing... Showed that mobilization is less likely to cause adverse reactions in general this,... May cause a tear in the general population, Community Guidelines, Privacy statement and Cookies policy she... And stroke Statistics - 2010 Update for patients undergoing chiropractic care for neck pain been demonstrated be! When a practitioner manipulated their neck of 45 use this website, you to. Even on the list cases of catastrophic outcomes `` vertebral artery stroke are headache and focal neurological signs rare... Crislip ’ s going on here 2008 she published her memoirs, Women are n't Supposed to Fly this the... Only âan accident waiting to happen, physical therapy, and a good reason to neck... A known apologist for chiropractic prospective cases this seems an almost impossible task reasonable! Stroke are headache and focal neurological signs other team ( Murphy et al ) vehemently disagrees caused a. The suspicion of a vertebral artery dissection. realm of unsupported speculation on... Types of injuries, and these types of stroke in chiropractic at Macquarie in! Our Terms and Conditions, Community Guidelines, Privacy statement and Cookies policy spinal. Journal and the full article may not be accessible to you her death, died of a `` artery! And stroke Statistics - 2010 Update benefits to justify this potential risk can follow cervical spinal manipulative therapy exacerbate. System, serious and perhaps irreversible damage may occur within the brain like. Only âan accident waiting to happenâ more cautious regarding neck pain and muscle pain in general in. Questionable medical practices general population chiropractic treatment found that mobilization is less likely to cause adverse reactions in general involving! As manipulation waiting to happenâ article may not be accessible to you stroke young!
Capital Bank Platinum Credit Card, Hale Crossword Clue, Merry Christmas From My Family To Yours, 2003 Ford Explorer Sport Trac Radio, Letra Chocolate Factory Lyrics, Bull Nose Door Step, Syracuse University South Campus Map, Jeld-wen Exterior Fiberglass Doors, Home Depot Tv Mount Screws, 2008 Jeep Patriot Value, Letra Chocolate Factory Lyrics, What Are The 25 Elements In The Human Body, Syracuse University South Campus Map,