Does anyone have an idea or that overuse of the neck can cause cerebral infarction resulted from thrombus in the internal carotid artery?
A 61-year-old male was brought to the emergency department with complaints of left side paralysis and speech disturbance. The symptoms supposedly appeared while he was sleeping. Apparently, the patient could not move his left hand and leg. He was alert and his blood pressure was 120/60 mmHg. He has no history of hypertension, diabetes, or hyperlipidemia. He does not consume alcohol or smoke. According to his wife, he complained of right side neck pain in the preceding day after he played Kendo _ Japanese martial art. There were no apparent bruises or wounds in his right neck.
USG revealed the thrombus at the trunk of right internal carotid artery. CT revealed no bleeding but the high intensity lesion in the right middle cerebral artery, indicating clots in the vessel. MRI showed the high intensity lesion in the right basal ganglia. MRA showed the deficit of the blood flow in the right ICA. Then, he was diagnosed as acute stroke resulting from thrombosis in the ICA. Thinking of the interval of the onset, he was not considered as a candidate of interventional radiology followed by iv t-PA treatment. Then, conservative treatment by edaravone and antithrombin agent were initiated.
In this case, I wonder if there are some relationships between sports and cerebral infarction. I am interested in the involvement of external force or overuse of neck as the cause of his illness.
This is typical for ICA dissection following trauma or rapid neck movements. Thrombus may develop in the dissection site and may embolize to intracranial vessels causing infarction, typically minutes/hours after the initial injury.
Hi, I don not believe performing Kendo as single reason for clotting/ disruption of the ICA. When you do or see a vascular surgeon handling the vessels, there is much more stress for the vessels and no initma damage.Thinking so, I assume there must be more to it. In most cases, pondering the age, cardiac rhythm irreguarities are the underlying cause for apoplex. Ask pt. for infection (Teeth, ear...) and so on. But Kendo is no accident as in trauma.
I follow the national karate team since end of nineties and never saw it, but what I did came across was the negative pressure in breathing excercises 'Sanchin' where a prolongued deep inspiratinn through nostrils is used to create a vacuum in the thgorax, this might be linked to your question
Thanks everyone for helping me with understanding the cause of this stroke! I sincerely felt that considering some external forces or influences as the cause of stoke is sometimes necessary.
Hi Nobuhiro
There is one case report published on this (Suzuki et al, 2012). The patient was a 66-year-old male who presented with left hemiplegia after having recieved a frontal thrust (tsuki) during the practice of Kendo. The authors state that the frontal thrust of Kendo can cause cervical artery dissection and stroke, but that's quite rare.
The reference is the following:
https://www.researchgate.net/publication/224871364_Common_Carotid_Artery_Dissection_Caused_by_a_Frontal_Thrust_in_Kendo_%28Japanese_Swordsmanship%29
Hope this is helpful to you
All the best
Rodrigo
Article Common Carotid Artery Dissection Caused by a Frontal Thrust ...
Dear Rodrigo
I appreciate you for finding the article for me which I really wanted! I have to learn the arterial dissection caused by external forces from my experience as well as this article. Thanks again for your cooperation!
Sincerely,
Nobuhiro
Nobuhiro,
This is very interesting case history. Repeated injuries as a result of rapid neck movements may result in endothelial damage and resulting thrombosis. However, as seen in this case, there must have been repeated injuries in the past which may have had resulted in atherosclerotic plaque development in the region and the recent rapid movement may have precipitated the event. Even otherwise severe acute rapid neck movements could contribute to endothelial damage and precipitate stroke. Quite possible.
Mr. Omer,
Thanks for giving me the kind comment and constructive opinion! If it is possible, I wanted to interview with him about the extent of his neck pain and duration which his neck pain lasted. It is interesting to think of repeated injuries as the possible cause of his stroke. I am looking forward to your continued support.
Sincerely,
Nobuhiro
Dear Nobuhiro,
Please let me know if I could be any further help. Please keep me posted about your interview with the person regarding extent of his neck pain and its duration. I will be happy to provide continued support in terms of exchange of ideas.
Omer
Forced cervical rotation may bring a stretch of the horizontal part of the vertebral artery with possible dissection; young people (especilly females, with long thin neck) are more prone to that. I had the occasion to intervene in the case of a 34 years man wich suffered protuberancyal infarctus with complete locked-in syndrome after a cervical manipulation in prone position. It is iase to conclude that in contact sport as you mentioned forced neck movement can be produced. The corresponding harm to the brain will depend of the damned artery and its extent. (MD and retired professor in PM%R)
I was to say exactly the same than Joan Garcia-Alsina : the vertebral artery can be stretched too much and it could lead to a dissection, more precisely after a forced rotation and/or extension of the neck to the rear (the combination of those two motions is particularly violent for the artery).
In this precise case, I'm thinking of two reflections that could be interesting :
-Maybe this is just a fortuity. Maybe if this man had done climbing before he would have had precisely the same problem
-The bruises and hits, on the neck or not, are one of the Virchow's triad for thrombus, because of the lesions on the endothelium. The thrombus could have be created in the left leg after a hit, then go back to the heart before being blocked in the ICA. Considering Virchow's triad, I would say that yes, every activity implying hits and shots can increase the risk of a thrombus, but that's a reasoning, not a data.
Thanks everyone for sharing interesting experiences regarding arterial dissection or injury during sports activities. I must say that I understood clearly about forces and damage which may cause to the endothelial thrombus. I keep focused on this phenomenon. I am glad to discuss with everyone over this topic.
An interesting point of discussion re. to the case I mentioned it was the elapsed time between forced nech motion and neurological symptoms. As I remember from the bibliographic revision we made at that time (more than 10 years ago), any accident occured within the previous 10 days could be considered potentially causative. This was the case on that occasion.
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