Dados do Trabalho

Título

Sports and trivial exercises as a trigger to cervical artery dissection: four case reports

Introdução/Fundamentos

Introduction: Cervical Artery Dissection (CeAD) is a potential disabling and lethal condition, accounting for less than 1-2% of strokes, which may be caused during sports and trivial exercises. In our Institute we had four CeAD's cases in few months. Clearly becomes fundamental the comprehension of this unusual but relevant scenario.

Objetivos

Objective: to describe our experience with these cases and improve the understanding of this condition.

Caso

Case Description: Patient 1: 28-year-old female had an intense headache and intermittent episodes of Broca’s aphasia after CrossFit. By means of a Cranial and Cervical Angiotomography (CTA) was viewed the dissection of the left internal carotid artery (ICA). The anticoagulation was initiated. After 3 days she was discharged without any neurological deficit. Patient 2: 35-year-old female experienced severe headache and left cervical pain after CrossFit. She reported past use of anabolic steroids and illicit drugs. The CTA revealed the dissection of the left vertebral artery (VA). She was treated with anticoagulation and discharged after 3 days without any neurological deficits. Patient 3: 49 -year-old male abruptly presented headache and dizziness during triathlon, followed by speech and gait disorder, getting hemiparetic. In the following day he was brought fainted to other Hospital. The patient underwent intravenous thrombolysis. An ICAD occlusion was diagnosed and it was chosen not to do the thrombectomy. It was prescript Pradaxa and Atorvastatina. As he wanted another medical opinion he came to our Hospital; we recommended substituting the Pradaxa for Marevan. Patient 4: 43-year-old female had gone to the gym and in the followed day had been woken disphasic and right hemiparetic. Then she was found unconscious and brought to our Hospital. It was diagnosed a left inferior frontoparietal stroke and left ICA dissection, with dysplasia in the right side. The choice was treating with AAS and, after acute phase, prescribed Clexane and Marevan. She progressed satisfactorily.

Conclusões/Considerações finais

Conclusions: It’s evident the most common initial symptoms in CeAD were headache and neckpain. Other manifestations, due to ischemic phenomenon, were usual. The CeAD had the capability to mimic a headache and migraine, which could increase the delay to seek out medical assistance. The suppositions were confirmed by neuroimaging, particularly with MRI and CTA. The anticoagulation treatment was successful in all patients, who evolved well without any sequels.

Palavras-chave

Keywords: cervical artery dissection; internal carotid artery dissection; vertebral artery dissection; sport; stroke

Área

Clínica Médica