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Yoshida K, Maeda T, Nitta Y, Suzuki K, Kurita H. A Sudden Unilateral Visual Field Loss in a Recreational Tennis Player: Cervical Internal Carotid Artery Dissection Associated With Low-Impact Sports. Cureus 2024; 16:e59305. [PMID: 38813322 PMCID: PMC11134497 DOI: 10.7759/cureus.59305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 05/31/2024] Open
Abstract
Traumatic cervical internal carotid artery dissection (CICAD) is a rare condition caused by blunt trauma to the neck, often through automobile- or sports-related collisions, assaults, or falls. Herein, we report an unusual case in which engaging in a low-impact sport (tennis) caused CICAD, without a direct injury. A 56-year-old man with hypertension suddenly experienced a visual field loss in his right eye while playing tennis. Carotid echocardiography revealed severe stenosis of the right internal carotid artery (ICA). Angiography revealed severe and irregular stenosis of the right ICA from the bifurcation to the petrous portion, suggesting CICAD. Upon admission, the patient had left upper visual field defects in his right eye and neck pain. Antiplatelet therapy was initiated with prasugrel (3.75 mg/day), with the intent to treat surgically if the stenosis or symptoms progressed. Follow-up angiography and magnetic resonance imaging showed gradual resolution of the stenosis, and the patient was discharged on day 28 with a modified Rankin Scale score of 1. The CICAD should be considered as a diagnosis for neurological symptoms, even in the context of low-impact sports such as tennis. Antithrombotic therapy is a reasonable first-line treatment for stable CICAD.
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Affiliation(s)
- Keijiro Yoshida
- Cerebrovascular Surgery, Saitama Medical University International Medical Center, Saitama, JPN
| | - Takuma Maeda
- Cerebrovascular Surgery, Saitama Medical University International Medical Center, Saitama, JPN
| | - Yusuke Nitta
- Neurosurgery, Tokorozawa Chuo Hospital, Tokorozawa, JPN
| | - Kaima Suzuki
- Cerebrovascular Surgery, Saitama Medical University International Medical Center, Saitama, JPN
| | - Hiroki Kurita
- Cerebrovascular Surgery, Saitama Medical University International Medical Center, Saitama, JPN
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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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Abstract
BACKGROUND Vertebral artery dissection (VAD) is a potentially catastrophic injury that may occur during sports participation. A comprehensive review is needed to collate documented cases to improve understanding and inform future preventative approaches. OBJECTIVE This review aimed to understand the extent of VAD in sport and characterise trends suggestive of mechanisms of injury. METHODS Electronic databases were searched using terms related to VAD and sport. Records were included if they described one or more cases of VAD attributed to sport. RESULTS A total of 79 records described 128 individual cases of VAD in sport, of which 118 were confirmed by imaging or autopsy and included in analyses. Cases were attributed to 43 contact and non-contact sports. The median age of cases was 33 years (IQR 22-44), and 75% were male. There were 22 cases of fatal injury, of which ten involved an impact to the mastoid region and seven involved an impact to the head or neck. Non-fatal cases of VAD were attributed to impact to the head or neck (not mastoid region), movement or held position without impact, and in some cases no reported incident. CONCLUSIONS VAD attributed to sports participation is uncommonly reported and the mechanisms are varied. Impact to the mastoid region is consistently implicated in fatal cases and should be the focus of injury prevention strategies in sport. Efforts may also be directed at improving the prognosis of cases with delayed presentation through clinical recognition and imaging. The review was registered on the international prospective register for systematic reviews ( http://www.crd.york.ac.uk/PROSPERO ) (CRD42018090543).
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Cristina-Oliveira M, Meireles K, Spranger MD, O'Leary DS, Roschel H, Peçanha T. Clinical safety of blood flow-restricted training? A comprehensive review of altered muscle metaboreflex in cardiovascular disease during ischemic exercise. Am J Physiol Heart Circ Physiol 2019; 318:H90-H109. [PMID: 31702969 DOI: 10.1152/ajpheart.00468.2019] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Blood flow restriction training (BFRT) is an increasingly widespread method of exercise that involves imposed restriction of blood flow to the exercising muscle. Blood flow restriction is achieved by inflating a pneumatic pressure cuff (or a tourniquet) positioned proximal to the exercising muscle before, and during, the bout of exercise (i.e., ischemic exercise). Low-intensity BFRT with resistance training promotes comparable increases in muscle mass and strength observed during high-intensity exercise without blood flow restriction. BFRT has expanded into the clinical research setting as a potential therapeutic approach to treat functionally impaired individuals, such as the elderly, and patients with orthopedic and cardiovascular disease/conditions. However, questions regarding the safety of BFRT must be fully examined and addressed before the implementation of this exercise methodology in the clinical setting. In this respect, there is a general concern that BFRT may generate abnormal reflex-mediated cardiovascular responses. Indeed, the muscle metaboreflex is an ischemia-induced, sympathoexcitatory pressor reflex originating in skeletal muscle, and the present review synthesizes evidence that BFRT may elicit abnormal cardiovascular responses resulting from increased metaboreflex activation. Importantly, abnormal cardiovascular responses are more clearly evidenced in populations with increased cardiovascular risk (e.g., elderly and individuals with cardiovascular disease). The evidence provided in the present review draws into question the cardiovascular safety of BFRT, which clearly needs to be further investigated in future studies. This information will be paramount for the consideration of BFRT exercise implementation in clinical populations.
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Affiliation(s)
- Michelle Cristina-Oliveira
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Kamila Meireles
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Marty D Spranger
- Department of Physiology, Michigan State University, East Lansing, Michigan
| | - Donal S O'Leary
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Tiago Peçanha
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
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Bilateral Traumatic Internal Carotid Artery Dissection after CrossFit Training. Ann Vasc Surg 2019; 61:466.e1-466.e5. [DOI: 10.1016/j.avsg.2019.04.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/20/2019] [Accepted: 04/11/2019] [Indexed: 11/20/2022]
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Hoda H, Takami H, Graffeo CS, Hanakawa K, Komiyama M, Murao M, Ide T. Sumo-Associated Traumatic Vertebral Artery Dissection Precipitating Subarachnoid Hemorrhage in Association with Bifid Origins of the Posterior Inferior Cerebellar Artery. World Neurosurg 2019; 134:641-646.e4. [PMID: 31610246 DOI: 10.1016/j.wneu.2019.09.164] [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: 09/07/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traumatic vertebral artery dissection (tVAD) is frequently accompanied by cerebellar infarction, but subarachnoid hemorrhage (SAH) is rare. CASE DESCRIPTION We report a unique case of tVAD precipitating SAH, from which the patient fully recovered, most likely because of the protective effects of an anomalously duplicated posterior inferior cerebellar artery (PICA) origin. A 17-year-old Sumo wrestler experienced a brief loss of consciousness after an attack by an opponent to his neck. Head computed tomography imaging demonstrated diffuse posterior fossa SAH; cerebral angiography demonstrated left vertebral artery (VA) occlusion, which was thought to be most likely attributable to tVAD. Angiography revealed distal PICA reconstitution, supplied by collateral arterial flow from the meningeal branch of the proximal ipsilateral VA. An external ventricular drain was placed acutely for treatment of SAH-induced hydrocephalus; however, the patient had an otherwise uneventful course, and remained without clinical evidence of ischemic infarct. A repeat imaging confirming a probable duplicated PICA origin from the VA, distal to the tVAD-associated thrombosis. CONCLUSIONS Of particular interest, the patient's abnormal anatomy may have been a mixed blessing, with a more fragile bifid PICA potentially underlying the unexpected development of SAH, whereas the sister branch simultaneously spared him a potentially catastrophic infarction via arterial collateralization.
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Affiliation(s)
- Hidenori Hoda
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan; Trauma and Critical Care Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
| | - Hirokazu Takami
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kazuo Hanakawa
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Masaki Komiyama
- Department of Neuro-Intervention, Osaka City General Hospital, Osaka, Japan
| | - Masahiko Murao
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Takafumi Ide
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
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Vertebral artery dissection in sport: Expert opinion of mechanisms and risk-reduction strategies. J Clin Neurosci 2019; 68:28-32. [PMID: 31399319 DOI: 10.1016/j.jocn.2019.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/14/2019] [Accepted: 07/04/2019] [Indexed: 11/23/2022]
Abstract
Experiential knowledge was collated to improve understanding of the mechanism of vertebral artery dissection (VAD) and inform recommendations for risk-reduction strategies in sport. Fourteen experts from fields of neurology, forensic pathology, biomedical engineering, radiology, physiotherapy, and sport and exercise medicine participated in semi-structured interviews. Experts were asked to provide their hypothesised mechanism of VAD, and suggest strategies to reduce the risk of VAD in non-motorised sports. Experts agreed that there is no single mechanism of VAD. Factors relating to predisposition, susceptibility, and an inciting event exist on a spectrum, as does the severity of the resulting VAD. Particularly concerning inciting events which may occur during sports participation include blunt force impact to the specific area behind and below the ear; and extreme movement of the neck, which may be facilitated by impact to the head or neck. Risk reduction strategies must be feasible within the particular sporting context. Strategies include rules, personal protective equipment, and education to reduce the risk of impact to the head or neck. Education may also serve to improve early recognition of VAD. VAD is a risk (low frequency, severe consequence) in sports in which athletes are exposed to head or neck impact from an object or opponent. Best practice risk management suggests that sports governing bodies should assess VAD risk and consider risk controls.
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Strambo D, Sirimarco G, Inácio N, Eskandari A, Michel P. Skiing Associated Stroke: Causes, Treatment, and Outcome. J Stroke Cerebrovasc Dis 2019; 28:288-294. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.09.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/24/2018] [Accepted: 09/28/2018] [Indexed: 11/28/2022] Open
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Morton A. Traumatic cricket‐related fatalities in Australia: a historical review of media reports. Med J Aust 2018; 209:142. [DOI: 10.5694/mja18.00401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/21/2018] [Indexed: 11/17/2022]
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10
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Traumatic vertebral artery dissection in high school rugby players: A report of two cases. J Clin Neurosci 2018; 47:137-139. [DOI: 10.1016/j.jocn.2017.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 10/02/2017] [Indexed: 11/19/2022]
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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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Bhattarai S, Elson W, Pradhan R, Pandey P. Cervical artery dissection at high altitude: an overview of two patients. J Travel Med 2016; 24:taw067. [PMID: 27799499 DOI: 10.1093/jtm/taw067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 09/01/2016] [Indexed: 11/14/2022]
Abstract
While altitude illness is common in the Himalayas, conditions unrelated to altitude illness also occur. High altitude cerebral oedema HACE is a global phenomenon of gradual onset affecting both cerebral hemispheres. We outline two cases of cervical artery dissection presenting with sudden onset of focal neurological symptoms at high altitude.
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Conforto AB. Challenges in diagnosis and treatment of cervico-cephalic arterial dissections. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:273-4. [DOI: 10.1590/0004-282x20160039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 01/15/2016] [Indexed: 11/22/2022]
Affiliation(s)
- Adriana Bastos Conforto
- Universidade de São Paulo, Brazil; Instituto Israelita de Ensino e Pesquisa Albert Einstein, Brazil
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