Common Carotid Artery Dissection Caused by a Frontal Thrust in Kendo (Japanese Swordsmanship)

Abstract

A 66-year-old right-handed man suddenly developed left hemiplegia after an opponent thrust at his neck with a bamboo sword during a practice game of Kendo (Japanese swordsmanship; Figure 1). Fifty minutes later, he visited our emergency service. His blood pressure was 77/55 mm Hg in the left arm but could not be measured in the right arm; his right radial artery was initially pulseless but became palpable 1 hour later. He was somnolent and had left unilateral spatial neglect, left complete hemiplegia, and left-sided sensory disturbance. Enhanced computed tomography (CT) showed an occlusion 15 mm distal to the origin of the right common carotid artery (CCA) without any abnormal findings at the aorta and innominate and right subclavian arteries. On emergent carotid ultrasonography, an intraluminal filling defect occupied the right CCA and swung back and forth with pulsation. He was …