TBI
Ramnik S. Gill, BS
Medical Student
University of Maryland School of Medicine
Leonardtown, Maryland, United States
Sarah Hour, MD
Fellow Physician
Mass General Brigham/Spaulding Rehabilitation
Boston, Massachusetts, United States
Martin Barylak, MD
Resident
Harvard/Spaulding
Charlestown, Massachusetts, United States
Shirley L. Shih, MD
Medical Director of Inpatient Brain Injury
Spaulding Rehabilitation Hospital
Charlestown, Massachusetts, United States
Ramnik S. Gill, BS
University of Maryland School of Medicine
Leonardtown, Maryland, United States
Right vertebral artery dissection in a power lifter with no known past medical history.
Case Description:
38 year old female with no known past medical history presented to the emergency department with loss of consciousness and decerebrate posturing. Patient had reported two days of neck pain radiating to the back of the head. CT imaging demonstrated a right vertebral artery dissection with basilar artery occlusion. Patient was given Tenecteplase and underwent mechanical thrombectomy with TICI 3 reperfusion. Subsequent MRI imaging demonstrated scattered infarcts in the brainstem, bilateral thalami, and right cerebellum. Etiology of vertebral artery dissection was unknown. Patient’s history of powerlifting was thought to be a possible contributing factor. Upon presentation to acute rehabilitation, patient required maximum assistance to total assistance for activities of daily living, transfers, and mobility. Patient was previously independent.
Discussions:
Vertebral artery dissection in younger to middle-aged patients make up 10-25% of reported strokes in this patient group. Cases have been attributed to a range of sports, including rugby, ice hockey, martial arts, golf, and running. Sports are a common trigger due to rapid movements of the neck, especially neck extension and rotation. Sports-related trauma can also act as a potential mechanical trigger. The most common causes of fatal cases are seen with impact to the mastoid region of the neck. Internal risk factors may also contribute, including the anatomy of the vessel and surrounding structures.
Conclusions:
Vertebral artery dissection is a commonly seen pathology in young patient populations who present with stroke. There is an underlying risk with high-intensity activities. Further prevention is needed in higher-risk sports; for example, sports equipment can be improved, or the rules of the sport may be modified to protect athletes. By doing so, the development of vertebral artery dissection and subsequent stroke in otherwise healthy individuals can be minimized.
