In the last 6 months, 2 patients have been admitted to our stroke center for ischemic stroke related to internal carotid artery (ICA) dissection that occurred during intensive video sports game practice with Wii ® gaming system, the new generation of interactive wireless gaming console. Wii ® has been widely distributed only since December 2006 and an increasing number of associated-injury cases have been reported in the literature since June 2007 (severe osteoarticular injuries involving shoulder or knee and hemothorax). 1-4 These cases illustrate the intensity of some efforts performed during the practice of these video sports games.Case presentation. Our first case is a previously healthy 47-year-old woman who developed stroke due to ICA and middle cerebral artery (MCA) occlusion related to proximal ICA dissection during intense sports video game practice with the Wii ® console system. She played a tennis video game for 3 hours consecutively, during which she experienced sudden severe left neck pain and unusual headache followed a few minutes later by right acute hemiplegia and aphasia (NIH Stroke Scale score ϭ 15). In spite of partial MCA recanalization after intravenous thrombolysis (IVT), the patient was still dependent (modified Rankin score ϭ 3) after 3 months.The second case is a previously healthy 14-year-old boy (weight ϭ 80 kg; height ϭ 190 cm) who developed acute right orbital pain and sudden left global hemiplegia immediately after 2 consecutive 3-hour sessions of intensive running on the spot on the interactive wireless balance board accessory of the Wii ® console system. Intracranial magnetic resonance angiography disclosed a right distal MCA occlusion related to intrapetrous ICA dissection. Full MCA recanalization was obtained after IVT but a left hemiparesis (modified Rankin score ϭ 2) persisted at 3 months.These patients had no cranial nerve palsy but patient 2 had a slight right Horner syndrome for a few days after stroke onset.ICA dissection was diagnosed by MRI and CT angioscan in the 2 cases (figure) and IVT was per-formed before 3 hours after stroke onset and then relayed 24 hours later by anticoagulation. There was no sign of multiple dissections on several CT angioscans performed during hospitalization and after 1 and 3 months.For each patient, a complete screening of wellknown factors associated with cervical artery dissection was done. They had no migraine, hyperhomocysteinemia, or visible stigmata of defined connective tissue disorders. Furthermore, in the 2 cases, CT angioscan and intracranial and cervical magnetic resonance angiography demonstrated no sign of tortuosity, kinking or coiling, or fibromuscular dysplasia.
Discussion.In these 2 cases, the relationship between the video game practice and the occurrence of dissection is likely: minor trauma during sport practice is a well-known precipitating factor for ICA dissection, no clear cause of dissection was been found, and both patients presented an unilateral acute heralding headache before stroke during the video sports game se...
