In reviewing Melikyan et al., we discuss what we think are weaknesses in the case report. The authors did not report on known risk factors for cerebrovascular accident and vertebral artery dissection. Known symptoms that appear early in vertebral artery dissection were not reported or denied, specifically related to changes in the patient's pattern of neck pain. Causality was assumed when only a weak temporal relation was involved. Finally, the case report makes it appear that the manipulation was performed by someone other than a chiropractor but therefore erroneously uses chiropractic in the title.