Internal Carotid Artery Dissection After Indirect Blunt Cervical Trauma in an Ice Hockey Goaltender
Internal carotid artery dissections are rare injuries that can result from both direct cervical trauma and indirect trauma causing sudden cervical hyperextension. Depending on the magnitude of the dissection, clinical presentation ranges from neurologic symptoms, such as Horner syndrome, to relatively mild but persistent headache symptoms, as in the case reported in this article. High clinical suspicion with subsequent neuroimaging is recommended in similar clinical scenarios. Our patient, an ice hockey goaltender, was conservatively treated with rest and serial neuroimaging studies to ensure resolution of the dissection. Eight weeks later, he returned to athletic competition with resolved symptoms and radiologically improved arterial stenosis.
Conclusion
We have reported the case of a 32-year-old professional hockey goaltender who presented with isolated, persistent, worsening headache of delayed onset after ICA dissection. The ICA dissection resulted from indirect trauma, with reaction to a puck causing acute hyperextension and rotational injury. To our knowledge, this is the first report of a case of ICA dissection in an athlete, lacking neurologic examination findings that could aid in the diagnosis. The index of suspicion for CAD should be high after direct or indirect cervical trauma when patients present with unilateral neck pain or headache, even in the absence of neurologic findings, as stroke is a catastrophic but preventable complication.
Am J Orthop. 2017;46(3):E139-E143. Copyright Frontline Medical Communications Inc. 2017. All rights reserved.
