The stroke that killed a 45-year-old woman 17 days after she underwent a chiropractic manipulation to treat her migraine headaches could have been triggered by trauma to the arteries in her neck, the neurologist who treated her testified at an inquest into her death yesterday.

Lana Lewis, a Toronto mother of three, died in September, 1996, after suffering a series of strokes following a visit to a chiropractor. A long-delayed inquest into her death began hearing testimony yesterday to determine whether the neck manipulation caused her death, and if it did, how similar deaths can be prevented.

Dr. Al-Noor Dhanani, a neurologist, was the first to testify. He said he first examined Ms. Lewis on Sept. 2, 1996, one day after her admission to the Queensway General Hospital. She was complaining of disorientation, head pain, lack of balance, feelings of nausea and difficulty with her memory.

The emergency doctor who examined her thought she might be suffering from muscle spasms. Dr. Dhanani suspected something more serious when he found her vision to be impaired and her reflexes abnormal.

He ordered a CT scan, which permits physicians to view the soft tissue of the brain, and an angiogram, which is a radiography of blood vessels. The tests confirmed his worst suspicion: Ms. Lewis had suffered a stroke. The angiogram further revealed that she had likely suffered a trauma to the left artery in the back of her head and possibly, to the artery on the right, precipitating the stroke.

Ms. Lewis was a smoker with untreated high blood pressure, she was somewhat overweight for her height, she had a family history of heart disease and was suffering from hardening of the arteries. Despite these factors, the doctor testified, a stroke in someone so young is highly unusual.

The first stroke was not fatal. Ms. Lewis was treated with blood thinners and improved enough over the next few days to be released from hospital on Sept. 6.

Four days later she was back, this time by ambulance. She had collapsed at home after complaining of a headache. Her speech was slurred, she was vomiting and not fully conscious. She had suffered a second, related stroke. She was pronounced dead two days later.

In his opening statement to the five-person jury, Tom Schneider, the Crown attorney, said they will hear that two neuro-pathologists who examined the autopsy findings at first concluded that the death was a result of chiropractic manipulation, but that one of them later changed his mind, instead attributing the death to natural causes.

Dr. Dhanani will likely be cross-examined today by one or all of the lawyers representing the five groups that have sought standing at the inquest: Ms. Lewis's family; the Canadian Memorial Chiropractic College and the Canadian Chiropractic Association; the College of Chiropractors of Ontario; Dr. Philip Emanuele, the chiropractor who treated her; as well as four of the physicians who treated her.

Seven members of Ms. Lewis's family attended court.

The family has spent $20,000 to date on the case.

Representatives from the Canadian Chiropractic Association were on hand at the hearing and distributed glossy informational pamphlets to the media citing studies on the safety of neck adjustments.