Vertebral artery dissection during Kung-Fu training

Abstract

Objective We describe a case of vertebral artery dissection during Kung-Fu practice. Materials and methods We describe a case of a 26-year-old male with no significant pathologies in his medical history. The patient was a non-smoker, did not drink alcohol, as well as did not take any kind of drug. He had no family history of neurological problems. The patient was a KungFu practitioner and was subjected to an annual medical examination for competitive sports, which never revealed anything pathological. During a training session, the patient made a quick movement with his head and trunk. The movement was performed in an uncoordinated way, in contrast to what usually happens in kung fu where the movements are characterized by excellent coordination. This incoordination led him to lose his balance and fall backwards, without head trauma. Subsequently, the patient stood up without any trouble, finishing his training. No pain to the neck or head was reported. Driving back home, the patient realized that he did not see well, and decided to go to the nearest Emergency Department. There, a brain CT scan and a neurological evaluation were performed, detecting no abnormalities. Therefore, he was discharged. The next morning, due to an unusual headache and to the persistence of visual impairment, he decided to come to our Emergency Department. We performed a neurological assessment, which showed a complete homonymous hemianopia of the right side. The patient was, therefore, subjected to brain CT scan, which showed a left occipital ischemic lesion. He was admitted to the Stroke Unit. During the hospitalization, Doppler ultrasound of supra aortic vessels showed the dissection of the left vertebral artery. The patient underwent cerebral angiography, which confirmed the dissection of the distal part of the left vertebral artery (Fig. 1–9). The possibility of being affected by Ehlers–Danlos’s syndrome, as well as Marfan’s syndrome and osteogenesis imperfecta, was excluded [1]. No history of migraine [2]. Hyperhomocysteinemia and MTHFR mutations were excluded [3]. Major trauma to the skull or chest was excluded. We also excluded whiplash injury and chiropractic manipulation as possible etiologies. An oral anticoagulant therapy was prescribed. An angiography, performed approximately 2 months after the onset of symptoms, showed the results of the dissection. Few cases of vertebral artery dissection during sport practices have been described in literature. None of these concerned the Kung-Fu [4, 5]. Discussion and conclusion The case described shows that even a simple movement of the head, already carried out several times in the past, can lead to the dissection of supra-aortic vessels [6]. We believe that it is important to remember that a sudden movement of the head can lead to a vessel dissection and that this can happen also without the patient experiencing any pain. F. Pacei (&) IRCCS Policlinico San Donato, P.za Malan 1, 20097 San Donato Milanese, MI, Italy e-mail: federico.pacei@gmail.com