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Stellpflug SJ, Dalrymple KA, Stone D, Southgate S, Bachman DS, LeFevere RC, Hasan J, Zwank MD. Impact of repeated sportive chokes on carotid intima media thickness and brain injury biomarkers in grappling athletes. PHYSICIAN SPORTSMED 2024:1-9. [PMID: 38857060 DOI: 10.1080/00913847.2024.2366154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/06/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE Vascular neck compression techniques, referred to as 'chokes' in combat sports, reduce cerebral perfusion, causing loss of consciousness or voluntary submission by the choked athlete. Despite these chokes happening millions of times yearly around the world, there is scant research on their long-term effects. This pilot study evaluated whether repeated choking in submission grappling impacts the carotid intima media thickness (CIMT) and brain injury biomarkers (NFL, hGFAP, t-Tau, and UCH-L1). METHODS Participants (n = 39, 29 male; ages 27-60 years) were assigned to one of two study arms: Grapplers (n = 20, 15 male) and 19 age/sex/body size matched controls. Grapplers had been exposed to >500 choke events while training for >5 years in a choke-inclusive sport. Exclusion criteria were recent TBI or deficits from a past TBI or stroke. Bilateral ultrasound measurement of the CIMT was performed, and blood was collected for quantitative analysis of four brain injury markers. Subgroup analyses were performed within the Grappler group to account for blunt head trauma as a possible confounder. RESULTS There was no overall difference in CIMT measurements between Grapplers (mean 0.55 mm, SD 0.07) and Controls (mean 0.57 mm, SD 0.10) p = 0.498 [95% CI -0.04-0.08], nor were there CIMT differences between Grappler subgroups of blunt Trauma and No-Trauma. There were no significant differences in any biomarkers comparing Grapplers and Controls or comparing Grappler subgroups of Trauma and No-Trauma. CONCLUSION This study found no significant difference in CIMT and serum brain injury biomarkers between controls and grapplers with extensive transient choke experience, nor between grapplers with extensive past blunt head trauma and those without.
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Affiliation(s)
| | | | - Daniel Stone
- Department of Emergency Medicine, Regions Hospital, Saint Paul, MN, USA
| | - Samuel Southgate
- Department of Emergency Medicine, Regions Hospital, Saint Paul, MN, USA
| | - David S Bachman
- Critical Care Research Center, HealthPartners, Saint Paul, MN, USA
| | - Robert C LeFevere
- Department of Emergency Medicine, Regions Hospital, Saint Paul, MN, USA
| | - Jaan Hasan
- Department of Emergency Medicine, Wyckoff Heights Medical Center, Brooklyn, NY, USA
| | - Michael D Zwank
- Department of Emergency Medicine, Regions Hospital, Saint Paul, MN, USA
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2
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Nakao J, Hosoo H, Muroi A, Takahashi T, Marushima A, Ishikawa E, Matsumaru Y. Traumatic dissection of the anterior cerebral artery secondary to a rugby related impact: A case report with emphasis on the usefulness of T1-VISTA. Surg Neurol Int 2023; 14:43. [PMID: 36895213 PMCID: PMC9990796 DOI: 10.25259/sni_1082_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Background Cerebrovascular injuries (CVIs) are not usually considered in the differential diagnosis of sport-related head injuries (SRHIs). We encountered a rugby player with traumatic dissection of the anterior cerebral artery (ACA) after impact on the forehead. Head magnetic resonance imaging (MRI) with T1-volume isotropic turbo spin-echo acquisition (VISTA) was used to diagnose the patient. Case Description The patient was a 21-year-old man. During a rugby tackle, his forehead collided with the forehead of an opponent. He did not have a headache or disturbance of consciousness immediately after the SRHI. On the 2nd day of illness, he had transient weakness of the left lower limb several times. On the 3rd day of illness, he visited our hospital. MRI revealed occlusion of the right ACA and acute infarction of the right medial frontal lobe. T1-VISTA revealed intramural hematoma of the occluded artery. He was diagnosed with acute cerebral infarction due to dissection of the ACA and was followed up for vascular changes with T1-VISTA. The vessel had recanalized and the size of the intramural hematoma had decreased 1 and 3 months after the SRHI, respectively. Conclusion Accurate detection of morphological changes in cerebral arteries is important for the diagnosis of intracranial vascular injuries. When paralysis or sensory deficits occur after SRHIs, it is difficult to differentiate between concussion from CVI. Athletes with red-flag symptoms after SRHIs should not merely be suspected to have concussion; they should be considered for imaging studies.
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Affiliation(s)
- Junzo Nakao
- Department of Stroke and Cerebrovascular Disease, University of Tsukuba Hospital
| | - Hisayuki Hosoo
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Ai Muroi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | | | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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3
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Stellpflug SJ, Dummer MF, Martin CD, Vera JA, LeFevere RC. Cervical Artery Dissections and Ischemic Strokes Associated with Vascular Neck Compression Techniques (Sportive Chokes). J Emerg Med 2022; 63:49-57. [PMID: 35934648 DOI: 10.1016/j.jemermed.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/03/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Strangulation as a fight-finishing maneuver in combat sports, termed "choking" in that context, occurs worldwide millions of times yearly. This activity can be trained safely, but devastating injuries can occur. OBJECTIVE Our aim was to present a case series of cervical artery dissections and ischemic strokes associated with sportive choking. Sharing these cases is meant to draw awareness, to assist emergency physicians in caring for these athletes, and to provide a platform for further research. METHODS Institutional Review Board approval was obtained. Participants consented for medical information transfer and anonymous academic reproduction. The minimum medical record information necessary for inclusion was a report of diagnosis-confirming advanced imaging. Participants were contacted for primary information in addition to what the medical records could provide and to confirm some information in the record (e.g., pertinent medical history, demographic characteristics, choking event description, medical care, and commentary on their current health). Medical records and additional first-hand information were reviewed and participants were included if they had a diagnosed dissection or stroke likely associated with a sportive choke. RESULTS Ten cases met all criteria for inclusion. There were 5 cases of carotid artery dissection, 3 cases of vertebral artery dissection, and 2 cases of ischemic stroke without dissection. Nine of 10 participants survived and 3 of 10 have returned to submission grappling training. CONCLUSIONS Cervical artery dissections and ischemic strokes can occur in association with sportive choking. Emergency physicians must be aware of the widespread nature of this activity and must be vigilant in approaching management of patients with symptoms consistent with these injuries.
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Affiliation(s)
| | - Matthew F Dummer
- Department of Emergency Medicine, Regions Hospital, Saint Paul, Minnesota
| | | | - Joshua A Vera
- Hazel Hawkins Memorial Hospital, Hollister, California
| | - Robert C LeFevere
- Department of Emergency Medicine, Regions Hospital, Saint Paul, Minnesota
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4
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Stellpflug SJ, Weber W, Dietrich A, Springer B, Polansky R, Sachs C, Hsu A, McGuire S, Gwinn C, Strack G, Riviello R. Approach considerations for the management of strangulation in the emergency department. J Am Coll Emerg Physicians Open 2022; 3:e12711. [PMID: 35445212 PMCID: PMC9013263 DOI: 10.1002/emp2.12711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Patients with a history of strangulation present to the emergency department with a variety of different circumstances and injury patterns. We review the terminology, pathophysiology, evaluation, management, and special considerations for strangulation injuries, including an overview of forensic considerations and legal framework for strangulation events.
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Affiliation(s)
| | - William Weber
- Section of Emergency Medicine The University of Chicago Chicago Illinois USA
| | - Ann Dietrich
- Department of Pediatrics and Emergency Medicine University of South Carolina School of Medicine Columbia South Carolina USA
| | - Brian Springer
- Department of Emergency Medicine Wright State University Dayton Ohio USA
| | - Robin Polansky
- Department of Emergency Medicine Cedars‐Sinai Medical Center Los Angeles California USA
| | - Carolyn Sachs
- Department of Emergency Medicine University of California, Los Angeles Los Angeles California USA
| | - Antony Hsu
- Department of Emergency Medicine St. Joseph Mercy Hospital Ann Arbor Michigan USA
| | - Sarayna McGuire
- Department of Emergency Medicine The Mayo Clinic Rochester Minnesota USA
| | - Casey Gwinn
- Training Institute on Strangulation Prevention Alliance for Hope International San Diego California USA
| | - Gael Strack
- Training Institute on Strangulation Prevention Alliance for Hope International San Diego California USA
| | - Ralph Riviello
- Department of Emergency Medicine The University of Texas: San Antonio San Antonio Texas USA
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5
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Doyle-Baker PK, Mitchell T, Hayden KA. Stroke and Athletes: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910047. [PMID: 34639349 PMCID: PMC8507848 DOI: 10.3390/ijerph181910047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 11/22/2022]
Abstract
Stroke (i.e., cerebrovascular accident) affects one in 10,000 people between the ages of 14 and 45; however, very little is known about the frequency and type of stroke that occurs in athletes. The risk of injury to the neurovascular structures may depend on the type of sport involvement, although, sport-specific incidence rates are not known. Therefore, the goal of our scoping review was to provide some guidance to better inform the development of a context-fit stroke model by summarizing studies on a broad research topic related to stroke or cerebrovascular accident in sport based on a strict athlete definition. We used the guidance of Arksey and O’Malley’s five-stage-process for a scoping review. Databases included MEDLINE(R) Epub Ahead of Print, In-Process & Other Non- Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R), and Embase (OVID databases); CINAHL Plus with Full Text, SportDiscus with Full Text (Ebsco databases); and Scopus. Publication dates were from 1979–2020 across nine different countries resulting in 39 individual cases of stroke with an athlete age range of 14–56 years (95% male). The major inciting event(s) prior to stroke onset were headaches (38.4%), head trauma (30.7%), and neck injury and/or vertebral artery dissection (20.5%). Several sporting activities were represented with American football as the most prevalent (30.7%). In summary, we found that sports with an aspect of impact, collision, or microtrauma can lead to subsequent stroke. These sport-related traumatic events were often difficult to diagnose because of the longer interval before ischemia occurred. Therefore, health care providers should be particularly attuned to the possibility of stroke when evaluating athletes presenting with or without neurological deficit.
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Affiliation(s)
- Patricia K. Doyle-Baker
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada;
- School of Architecture, Planning, and Landscape, University of Calgary, Calgary, AB T2N 1N4, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T3B 6A8, Canada
- Correspondence: ; Tel.: +1-403-220-7034
| | - Timothy Mitchell
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - K. Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, AB T2N 1N4, Canada;
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Engelter ST, Traenka C, Grond-Ginsbach C, Brandt T, Hakimi M, Worrall BB, Debette S, Pezzini A, Leys D, Tatlisumak T, Nolte CH, Lyrer P. Cervical Artery Dissection and Sports. Front Neurol 2021; 12:663830. [PMID: 34135851 PMCID: PMC8200565 DOI: 10.3389/fneur.2021.663830] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/29/2021] [Indexed: 12/29/2022] Open
Abstract
Cervical artery dissection (CeAD) occurring in the context of sports is a matter of concern for CeAD patients. They seek advice on the role of sports in CeAD and on the safety of resuming sports after CeAD. The scarcity of studies and guidelines addressing these issues poses a challenge. We aimed at summarizing the current knowledge about CeAD and sports in order to provide an informed, comprehensive opinion for counseling CeAD patients. We took into account pathophysiological considerations, observations of cases reports, series, and registries, and conclusions by analogy from aortic dissection or inherited connective tissue syndromes. In summary, practicing active sports as the cause of CeAD seems uncommon. It seems recommendable to refrain from any kind of sports activities for at least 1 month, which can be extended in case of an unfavorable clinical or neurovascular course. We recommend starting with sport activities at low intensity—preferably with types of endurance sports—and to gradually increase the pace in an individually tailored manner, taking into circumstances of the occurrences of the CeAD in the individual patient (particularly in relation to sports), the meaning of sports activities for the individual well-being, the presence or absence of comorbidities and of neurological sequela, neurovascular findings, and whether there are signs of an underlying connective tissue alteration. Major limitations and several forms of bias are acknowledged. Still, in the absence of any better data, the summarized observations and considerations might help clinicians in advising and counseling patients with CeAD in clinical practice.
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Affiliation(s)
- Stefan T Engelter
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.,Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Christopher Traenka
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.,Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Caspar Grond-Ginsbach
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland.,Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Brandt
- Schweizerische Unfallversicherungsanstalt (SUVA), Swiss National Accident Insurance Institution, Lucerne, Switzerland
| | - Maani Hakimi
- Department of Vascular Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Bradford B Worrall
- Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville, VA, United States
| | - Stephanie Debette
- Department of Neurology, Bordeaux University Hospital, Bordeaux, France.,Inserm U1219, Bordeaux, France
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Didier Leys
- Univ-Lille, Inserm U1171, Centre Hospitalier Universitaire (CHU) Lille, Lille, France
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital and Department of Clinical Neuroscience, Institute for Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Christian H Nolte
- Department of Neurology, and Center for Stroke Research Berlin Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Philippe Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
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7
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Miranda S, Marques A. Pilates in noncommunicable diseases: A systematic review of its effects. Complement Ther Med 2018; 39:114-130. [PMID: 30012382 DOI: 10.1016/j.ctim.2018.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/31/2018] [Accepted: 05/31/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Chronic cardiovascular diseases, cancer, chronic respiratory diseases and diabetes are the four major groups of non-communicable diseases (NCDs) and the main cause of mortality worldwide. Pilates has been described as an effective intervention to promote healthy behaviors and physical activity in people with chronic diseases. However, the evidence of its effects in NCDs have not been systematized. We investigated the effects of Pilates in the four major groups of NCDs. DESIGN A systematic review was performed. Searches were conducted on Cochrane Library, EBSCO, PubMed, Science Direct, Scopus and Web of Science databases. Studies were rated with the quality assessment tool for quantitative studies. As a meta-analysis was not possible to conduct, a best-evidence synthesis was used. RESULTS Twelve studies, mostly of moderate quality, were included with 491 participants (78.6% females; age range 13-70 years old) with breast cancer (n = 3), diabetes (n = 3), chronic stroke (2 years post stroke) (n = 2), chronic obstructive pulmonary disease (n = 1), cystic fibrosis (n = 1), heart failure (n = 1) and arterial hypertension (n = 1). The best-evidence synthesis revealed strong evidence for improving exercise tolerance; moderate evidence for improving symptoms, muscle strength and health-related quality of life and limited or conflicting evidence on vital signs, metabolic parameters, body composition, respiratory function, functional status, balance, flexibility and social support. CONCLUSIONS Pilates should be considered for patients with NCDs, as it improves exercise tolerance. Future studies with robust methodologies are still needed to clarify its effectiveness on outcomes with moderate, limited or conflicting evidence and to establish the most suitable intervention protocol.
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Affiliation(s)
- Sara Miranda
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute for Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal.
| | - Alda Marques
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute for Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal.
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8
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Claudino JG, Gabbett TJ, Bourgeois F, Souza HDS, Miranda RC, Mezêncio B, Soncin R, Cardoso Filho CA, Bottaro M, Hernandez AJ, Amadio AC, Serrão JC. CrossFit Overview: Systematic Review and Meta-analysis. SPORTS MEDICINE - OPEN 2018; 4:11. [PMID: 29484512 PMCID: PMC5826907 DOI: 10.1186/s40798-018-0124-5] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 02/07/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND CrossFit is recognized as one of the fastest growing high-intensity functional training modes in the world. However, scientific data regarding the practice of CrossFit is sparse. Therefore, the objective of this study is to analyze the findings of scientific literature related to CrossFit via systematic review and meta-analysis. METHODS Systematic searches of the PubMed, Web of Science, Scopus, Bireme/MedLine, and SciELO online databases were conducted for articles reporting the effects of CrossFit training. The systematic review followed the PRISMA guidelines. The Oxford Levels of Evidence was used for all included articles, and only studies that investigated the effects of CrossFit as a training program were included in the meta-analysis. For the meta-analysis, effect sizes (ESs) with 95% confidence interval (CI) were calculated and heterogeneity was assessed using a random-effects model. RESULTS Thirty-one articles were included in the systematic review and four were included in the meta-analysis. However, only two studies had a high level of evidence at low risk of bias. Scientific literature related to CrossFit has reported on body composition, psycho-physiological parameters, musculoskeletal injury risk, life and health aspects, and psycho-social behavior. In the meta-analysis, significant results were not found for any variables. CONCLUSIONS The current scientific literature related to CrossFit has few studies with high level of evidence at low risk of bias. However, preliminary data has suggested that CrossFit practice is associated with higher levels of sense of community, satisfaction, and motivation.
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Affiliation(s)
- João Gustavo Claudino
- School of Physical Education and Sport, Laboratory of Biomechanics, University of São Paulo, São Paulo, Brazil
- Faculty of Physical Education, University of Itaúna, Itaúna, Brazil
| | - Tim J. Gabbett
- Gabbett Performance Solutions, Brisbane, Australia
- Institute for Resilient Regions, University of Southern Queensland, Ipswich, Australia
| | - Frank Bourgeois
- Sport Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Helton de Sá Souza
- Department of Psychobiology, Federal University of São Paulo, São Paulo, Brazil
| | | | - Bruno Mezêncio
- School of Physical Education and Sport, Laboratory of Biomechanics, University of São Paulo, São Paulo, Brazil
| | - Rafael Soncin
- School of Physical Education and Sport, Laboratory of Biomechanics, University of São Paulo, São Paulo, Brazil
| | | | - Martim Bottaro
- College of Physical Education, University of Brasília, Brasília, Brazil
| | | | - Alberto Carlos Amadio
- School of Physical Education and Sport, Laboratory of Biomechanics, University of São Paulo, São Paulo, Brazil
| | - Julio Cerca Serrão
- School of Physical Education and Sport, Laboratory of Biomechanics, University of São Paulo, São Paulo, Brazil
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9
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Do KH, Leggit JC, Galifianakis A. Extracranial Vertebral Artery Dissecting Aneurysm with Snowboarding: A Case Report. Curr Sports Med Rep 2018; 17:16-19. [PMID: 29315103 DOI: 10.1249/jsr.0000000000000441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Schlemm L, Nolte CH, Engelter ST, Endres M, Ebinger M. Cervical artery dissection after sports - An analytical evaluation of 190 published cases. Eur Stroke J 2017; 2:335-345. [PMID: 31008325 DOI: 10.1177/2396987317720544] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/19/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction Cervical artery dissections may be preceded by mechanical trigger events, often related to sports. Methods Using the MEDLINE database, we identified case reports and case series of sports-related cervical artery dissections. Information of the type of sport, age and gender of the patient, affected vessels, associated infarction, time delay, and neurological sequelae were extracted. Demographic and clinical characteristics were compared between sport groups using analysis of variance and Chi square tests. Differences were further assessed with adjusted post hoc tests and homogenous subsets. Results A total of 115 reports describing 190 patients with cervical artery dissections related to 45 different sports were identified. The mean age of all patients was 35 years; 26% of all patients were women. Anterior and posterior circulation, as well as left and right side were affected with similar frequency. Patients belonging to different sport categories differed significantly with regard to age (p < 0.001), gender (p < 0.001), and affected circulation (anterior vs. posterior, p = 0.02). The posterior circulation was most often affected in golf players (88%) and least often in individuals engaging in exercise (23%) and scuba divers (29%). Laterality (left vs. right) and mortality were similar between sport groups. Discussion We performed a comprehensive review and analytical evaluation of case reports describing patients with cervical artery dissections after sport. Confirmation of our findings in prospective studies is needed. Conclusion Cervical artery dissection has been described in relation to a wide variety of sports. The risk of injury to particular neurovascular structures may depend on the type sport involved. Discipline-specific incidence rates are not known.
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Affiliation(s)
- Ludwig Schlemm
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,London School of Economics and Political Science, London, UK
| | - Christian H Nolte
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland.,Neurorehabilitation Unit, University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, University of Basel, Basel, Switzerland
| | - Matthias Endres
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany.,DZNE (German Center for Neurodegenerative Diseases), Partner Site, Berlin, Germany
| | - Martin Ebinger
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, MEDICAL PARK Berlin Humboldtmühle, Berlin, Germany
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11
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Mizobuchi Y, Nagahiro S. A Review of Sport-Related Head Injuries. Korean J Neurotrauma 2016; 12:1-5. [PMID: 27182494 PMCID: PMC4866563 DOI: 10.13004/kjnt.2016.12.1.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 02/25/2016] [Accepted: 03/02/2016] [Indexed: 12/14/2022] Open
Abstract
We review current topics in sport-related head injuries including acute subdural hematoma (ASDH), traumatic cerebrovascular disease, cerebral concussion, and chronic traumatic encephalopathy (CTE). Sports-related ASDH is a leading cause of death and severe morbidity in popular contact sports like American football and Japanese judo. Rotational acceleration can cause either cerebral concussion or ASDH due to rupture of a parasagittal bridging vein. Although rare, approximately 80% of patients with cerebral infarction due to sport participation are diagnosed with ischemia or infarction due to arterial dissection. Computed tomography angiography, magnetic resonance angiography, and ultrasound are useful for diagnosing arterial dissection; ultrasound is particularly useful for detecting dissection of the common and internal carotid arteries. Repeated sports head injuries increase the risks of future concussion, cerebral swelling, ASDH, and CTE. To avoid fatal consequences of CTE, it is essential to understand the criteria for safe post-concussion sports participation. Once diagnosed with a concussion, an athlete should not be allowed to return to play on the same day and should not resume sports before the concussion symptoms have completely resolved. Information about the risks and management of head injuries in different sports should be widely disseminated in educational institutions and by sport organization public relations campaigns.
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Affiliation(s)
- Yoshifumi Mizobuchi
- Department of Neurosurgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Shinji Nagahiro
- Department of Neurosurgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
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12
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Sousa Nanji L, Melo TP, Canhão P, Fonseca AC, Ferro JM. Subarachnoid Haemorrhage and Sports. Cerebrovasc Dis Extra 2015; 5:146-51. [PMID: 26648972 PMCID: PMC4662293 DOI: 10.1159/000441395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 09/29/2015] [Indexed: 12/28/2022] Open
Abstract
Background Some cases of subarachnoid haemorrhage (SAH) have been associated with vigorous physical activity, including sports. Our research aimed to describe the association between SAH and sports and to identify the types of sports that were more frequently found as precipitating factors in a tertiary single-centre SAH register. Methods We retrieved information from a prospectively collected SAH registry and reviewed discharge notes of acute SAH patients admitted to the Stroke Unit of Hospital de Santa Maria, Lisbon, between 1995 and 2014. Results Out of 738 patients included in the analysis, 424 (57.5%) cases of SAH were preceded by physical activity. Nine cases (1.2%) were associated with sports, namely running (2 cases), aerobics (2 cases), cycling, body balance, dance, surf and windsurf. Patients with SAH while practicing sports were younger than controls (average age 43.1 vs. 57.0 years; p = 0.007). In 1 patient, there was a report of trauma to the neck. Patients in the sports group only had Hunt and Hess scale grades 1 (11.1%) or 2 (88.9%) at admission, while patients in the control group had a wider distribution in severity. Conclusions Our findings indicate that SAH precipitated by sports is not very frequent and is uncommonly related to trauma. Patients who suffered SAH associated with sports were younger and apparently had a milder clinical presentation.
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Affiliation(s)
| | - Teresa P Melo
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal ; Neurology/Stroke Unit, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
| | - Patrícia Canhão
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal ; Neurology/Stroke Unit, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
| | - Ana Catarina Fonseca
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal ; Neurology/Stroke Unit, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
| | - José Manuel Ferro
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal ; Neurology/Stroke Unit, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
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13
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Fragoso YD, Adoni T, Amaral LLFD, Braga FT, Brooks JBB, Campos CS, Comini-Frota ER, Ferreira NPFD, Giacon LMT, Gomes S, Goncalves MVM, Magalhaes PSC, Matta APDC, Oliveira FTMD, Oliveira JFD, Pierucettti MA, Pereira SLDA, Pontes ME, Siquineli F, Tauil CB, Troaini GN. Cerebrum-cervical arterial dissection in adults during sports and recreation. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 74:275-9. [DOI: 10.1590/0004-282x20150150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 08/06/2015] [Indexed: 11/21/2022]
Abstract
Dissection of cervical arteries constitutes a medical emergency. Although relatively rarely, activities classified as sports and recreation may be a cause of arterial dissection independently of neck or head trauma. The purpose of the present paper was to present a series of cases of cerebrum-cervical arterial dissection in individuals during or soon after the practice of these sports activities. Methods Retrospective data on patients with arterial dissection related to sports and recreation. Results Forty-one cases were identified. The most frequently affected vessel was the vertebral artery. A large variety of activities had a temporal relationship to arterial dissection, and jogging was the most frequent of these. This is the largest case series in the literature. Conclusion Arterial dissection may be a complication from practicing sports.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sidney Gomes
- Hospital Beneficência Portuguesa de São Paulo, Brazil; Hospital Paulistano, Brazil
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14
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Abstract
Lifestyle modifications and environmental factors are important for stroke prevention and rehabilitation after stroke. The individual stroke risk may be modified by factors like physical activity, body weight and nutrition, special dietary supplements such as vitamins, smoking, consumption of tea, coffee and alcohol, psychological factors and by keeping a pet. The focus of this article lies on measures for stroke prevention. For certain topics, it also comments on factors that are important during rehabilitation after stroke.
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Affiliation(s)
- L M Gerischer
- Klinik und Hochschulambulanz für Neurologie, Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Deutschland
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