Background: Cervical and lumber spine manipulation therapy is widely used treatment of spinal degenerative disc disease. Serous side affects can be associated with this treatment especially in cervical spine. Stroke represents an infrequent adverse reaction associated with cervical spine manipulation therapy. Methods: 34 year old lady presented to Emergency Department (ED) referring Hospital 20 minutes after having neck manipulation by a chiropractor, she complained of neck pain after the manipulation with syncope, half hour later developed visual field loss, with few episodes of emesis, and increasing headache. Results: The patient was started on Aspirin and admitted locally for observation. Computers tomography (CT) head , CT-Angiography showed left Vertebral artery (V3 segment) , MRI showed acute infarction within the both cerebellar hemisphere, after 3 days patient transferred to our unit, patient had posterior fossa decompressive craniotomy with external ventricular drainage (EVD), discharged to rehabilitation 2 weeks, 2 months follow-up patient improving. Conclusions: There is inceased evidence that shows increased association between spinal manipulation and adverse effects and dissection of vertebral arteries in younger population. Younger patients (< 45 years) are particulary high risk, they should be informed of the risk of stroke or vascular injury from this procedure. No aggresive manipulation in younger population.