SHM Converge Scientific Abstract ePoster Gallery-A Workout Nightmare: Rare Case of Vertebral Artery Dissection

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This case report describes a rare vertebral artery dissection (VAD) in a healthy 50-year-old man who developed acute vertigo, imbalance, nausea, and vomiting while weightlifting at the gym. He had experienced two days of left-sided neck pain beforehand. Although his initial CT head and CT angiogram were negative and his NIH stroke score was 0, MRI later revealed acute-to-subacute posterior circulation strokes involving both cerebellar hemispheres, the left thalamus, and the medial left occipital lobe. Re-review of the CTA with 3D reconstruction showed mild irregularity of the distal left extracranial vertebral artery at C1-C2, consistent with symptomatic VAD.<br /><br />The patient had no major vascular risk factors, and echocardiography ruled out a cardioembolic source. He was treated with aspirin and started on atorvastatin after LDL was found to be 75 mg/dL. He remained stable, normotensive, and was discharged home without residual neurologic deficits.<br /><br />The authors suggest that the dissection was likely caused by neck hyperextension during heavy bench lifting, a mechanism that can mechanically injure the vertebral artery as it passes through the cervical spine. The report highlights that VAD can occur even in relatively healthy individuals and may be triggered by exercise-related neck strain. It also emphasizes that symptoms such as neck pain, vertigo, and nausea may appear before stroke symptoms and can be delayed by up to two weeks, making diagnosis challenging.<br /><br />Overall, the case underscores the importance of considering VAD in patients with vague neurologic symptoms after strenuous exercise, even when standard initial imaging is unrevealing.

Asset Subtitle

Aakash Patel

Meta Tag

Author List Aakash Patel, Sagar C. Patel, Usha Anand

Category Clinical Vignettes

Concept Vertebral Artery Dissection

Concept Posterior Circulation Stroke

Concept Neck Hyperextension

Concept Neck Rotation

Concept Neck Pain

Distinguished Non-Finalist

Presenter Organization Wellstar Kennestone Hospital

Presenting Author Aakash Patel

Track Adult

Keywords

vertebral artery dissection

posterior circulation stroke

weightlifting

acute vertigo

neck pain

cerebellar infarction

CT angiogram

MRI brain

exercise-related injury

vertebrobasilar ischemia

Vertebral Artery Dissection

Posterior Circulation Stroke

Neck Hyperextension

Neck Rotation

Neck Pain