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Images in Neurology |

Multiple Cervical Artery Dissection in a Volleyball Player

Petar Slankamenac, PhD; Aleksandar Jesic, MD; Predrag Avramov, MD; Zeljko Zivanovic, MD; Stanko Covic, MD; Viktor Till, PhD
Arch Neurol. 2010;67(8):1024. doi:10.1001/archneurol.2010.160.
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A 23-year-old volleyball player started experiencing tingling, numbness, and mild pain in his right hand, which gradually progressed to his forearm and shoulder. Two months later while playing a volleyball match, he suddenly experienced occipital pain followed by vision loss and left-side weakness. Fifteen minutes later, he recovered except for a strong persisting headache. The following day, he woke up with weakness in his left arm and leg and could not talk properly.

On admission he was somnolent, confused, and dysarthric and had left facial nerve palsy and left hemiparesis. His right radial pulse was not palpable. Magnetic resonance imaging showed infarction of the right cerebral hemisphere (Figure) and asymptomatic right cerebellar lobe infarction (Figure, B). Magnetic resonance angiography revealed right subclavian artery occlusion, right internal carotid occlusion, and proximal stenosis of the right vertebral artery, the latter two highly suggestive of dissections (Figure).

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Magnetic resonance imaging and magnetic resonance angiography. A, Ischemic infarction in the region of middle cerebral artery irrigation. B, Cerebellar infarction. C, After subclavian artery stenting. D, Subclavian artery occlusion, internal carotid occlusion, and vertebral artery stenosis suggestive of dissection (arrows).

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