Jorge G. Burneo, MD, Rhonna Shatz, DO, Nikolaos I.H. Papamitsakis, MD, Panayiotis D. Mitsias, MD,
Detroit, MI
A previously healthy 30-year-old man presented to the emergency room 2 days after a roller-coaster ride complaining of diplopia and cervical pain. There was no trauma during the roller-coaster ride. His medical history was unremarkable. Examination revealed no meningeal signs and a right homonymous hemianopsia.
Diffusion-weighted MRI revealed an acute left occipital lobe infarct (figure, A). Proton density–weighted sequence showed absence of the normal flow void in the left vertebral artery (arrow in figure, B). MR angiography showed absence of the distal portion of the left vertebral artery (arrow in figure, C). Cerebral angiography revealed an area of stenosis of the left vertebral artery, in the C2-C1 segment (arrow in figure, D). The imaging studies supported the clinical diagnosis of left vertebral artery dissection (VAD) and left occipital infarction. The patient was placed on anticoagulation for 6 months and subsequently on aspirin. He has no recurrent cerebral ischemia after 10 months of follow-up.
Neck hyperextension almost always occurs during roller-coaster rides. VAD can result from rotational forces applied to the third segment of the artery at the C2 and C1 vertebral levels. The dissection leads to stenosis of the true lumen and disruption of the epithelium. The resulting slow flow, turbulence, or endothelial irregularity can lead to local thrombus formation and subsequent artery-to-artery embolism, usually to the posterior cerebral artery. VAD should be considered in the differential diagnosis of vertebrobasilar territory ischemia in young adults, even when there is no preceding trauma. Stroke occurring after a roller-coaster ride should be considered due to extracranial vessel dissection until proven otherwise. This case joins the series of neurologic injuries reported in the literature due to roller-coaster rides.1,2
1. Biousse V, Chabriat H, Amarenco P, Bousser MG. Roller-coaster-induced vertebral artery dissection. Lancet 1995; 346(8977):767.
2. Fukutake T, Mine S, Yamakami I, Yamaura A, Hattori T. Roller-coaster headache and subdural hematoma. Neurology 2000;54:264.
Figure. (A) Diffusion-weighted MRI revealed an acute left occipital lobe infarct. (B) Proton density–weighted sequence showed absence of the normal flow void in the left vertebral artery (arrow). (C) MR angiography showed absence of the distal portion of the left vertebral artery (arrow). (D) Cerebral angiography revealed an area of stenosis of the left vertebral artery, in the C2-C1 segment (arrow).
Letters: Rapid online correspondence
REQUIREMENTS
If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Hemiplegic Migraine Associated With PRRT2 Variations A Clinical and Genetic Study
Dr. Robert Shapiro and Dr. Amynah Pradhan