Cervical Artery Dissection and Sports.

Stefan T Engelter,Maani Hakimi,Philippe Lyrer,Stephanie Debette,Didier Leys,Bradford B Worrall,Christian H Nolte,Christopher Traenka,Tobias Brandt,Caspar Grond-Ginsbach,Turgut Tatlisumak,Alessandro Pezzini

doi:10.3389/fneur.2021.663830

Abstract

Cervical artery dissection (CeAD) occurring in the context of sports is a matter of concern for CeAD patients. They seek advice on the role of sports in CeAD and on the safety of resuming sports after CeAD. The scarcity of studies and guidelines addressing these issues poses a challenge. We aimed at summarizing the current knowledge about CeAD and sports in order to provide an informed, comprehensive opinion for counseling CeAD patients. We took into account pathophysiological considerations, observations of cases reports, series, and registries, and conclusions by analogy from aortic dissection or inherited connective tissue syndromes. In summary, practicing active sports as the cause of CeAD seems uncommon. It seems recommendable to refrain from any kind of sports activities for at least 1 month, which can be extended in case of an unfavorable clinical or neurovascular course. We recommend starting with sport activities at low intensity—preferably with types of endurance sports—and to gradually increase the pace in an individually tailored manner, taking into circumstances of the occurrences of the CeAD in the individual patient (particularly in relation to sports), the meaning of sports activities for the individual well-being, the presence or absence of comorbidities and of neurological sequela, neurovascular findings, and whether there are signs of an underlying connective tissue alteration. Major limitations and several forms of bias are acknowledged. Still, in the absence of any better data, the summarized observations and considerations might help clinicians in advising and counseling patients with CeAD in clinical practice.

Highlights

Cervical artery dissection (CeAD) is a major cause of stroke in younger adults [1, 2]
CeADs as well as aortic dissections have been reported related to heavy weight lifting [7, 39]
Unfavorable blood pressure effect on the arterial wall has been observed in a model of CeAD [41]

Summary

INTRODUCTION

Cervical artery dissection (CeAD) is a major cause of stroke in younger adults [1, 2]. 40% of the CeAD patients reported any kind of recent head or neck trauma in the month prior to symptom onset [4], as compared to 10% of the patients with ischemic stroke attributable to a cause other than CeAD and 20% of the healthy controls [4]. Mortality rates of 17 and 7% in reviews summarizing sportsassociated CeAD events [5, 7] exceed those of hospital-based registries of CeAD patients [1, 2] This difference may suggest a poorer prognosis of sports-related CeAD than CeAD in general, the risk of an underlying recruitment bias (i.e., participation in CADISP required informed consent), as well as a publication bias, is likely to be present

DISCUSSION

LIMITATIONS

Findings

DATA AVAILABILITY STATEMENT