Carotid artery dissection plus subdural hematoma after a roller-coaster ride

Abstract

A 31-year-old woman with history of antiphospholipid syndrome treated with warfarin reported two days after a roller-coaster ride, sudden onset of paresthesias in the right side of the face and in the right hand, followed by headache. Neuroimaging results are shown in Figures 1 and 2.The "blood/fluid level" represented by the interface between plasma and sedimented blood (Figure 1) can be seen in hemorrhages related to bleeding disorders, among other causes 1 . We suspect that the sudden head and neck movements during the roller-coaster ride contributed to the remarkably unusual combination of subdural hematoma and carotid artery dissection ( Figure 2) in this patient. There is an intimal flap and a patent false lumen.

Speechless After a Roller Coaster Ride

“…6 Dissection of the carotid and vertebral arteries have been described in adults, following roller coaster rides, especially in those individuals who are on antiplatelet agents and anticoagulants. 7,8 The neck is subjected to complex unpredictable movements, including rotational and directional changes, as well as strong gravitational forces during roller coaster rides, which may predispose to intimal tears in the mobile portions of the major cervical vessels. 9,10 Following such a tear, there is tracking of blood into the subintimal tissue with creation of a thrombus in the wall of the vessel.…”