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Vertebral Artery Dissection in Sport: A Systematic Review

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Abstract

Background

Vertebral artery dissection (VAD) is a potentially catastrophic injury that may occur during sports participation. A comprehensive review is needed to collate documented cases to improve understanding and inform future preventative approaches.

Objective

This review aimed to understand the extent of VAD in sport and characterise trends suggestive of mechanisms of injury.

Methods

Electronic databases were searched using terms related to VAD and sport. Records were included if they described one or more cases of VAD attributed to sport.

Results

A total of 79 records described 128 individual cases of VAD in sport, of which 118 were confirmed by imaging or autopsy and included in analyses. Cases were attributed to 43 contact and non-contact sports. The median age of cases was 33 years (IQR 22–44), and 75% were male. There were 22 cases of fatal injury, of which ten involved an impact to the mastoid region and seven involved an impact to the head or neck. Non-fatal cases of VAD were attributed to impact to the head or neck (not mastoid region), movement or held position without impact, and in some cases no reported incident.

Conclusions

VAD attributed to sports participation is uncommonly reported and the mechanisms are varied. Impact to the mastoid region is consistently implicated in fatal cases and should be the focus of injury prevention strategies in sport. Efforts may also be directed at improving the prognosis of cases with delayed presentation through clinical recognition and imaging.

The review was registered on the international prospective register for systematic reviews (http://www.crd.york.ac.uk/PROSPERO) (CRD42018090543).

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References

  1. Lee VH, Brown RD, Mandrekar JN, Mokri B. Incidence and outcome of cervical artery dissection: a population-based study. Neurol. 2006;67(10):1809–12.

    Article  Google Scholar 

  2. Finch C. A new framework for research leading to sports injury prevention. J Sci Med Sport. 2006;9(1):3–9. https://doi.org/10.1016/j.jsams.2006.02.009.

    Article  PubMed  Google Scholar 

  3. Wilkinson IS. The vertebral artery: extracranial and intracranial structure. Arch Neurol. 1972;27(5):392–6. https://doi.org/10.1001/archneur.1972.00490170024004.

    Article  CAS  PubMed  Google Scholar 

  4. Ong BB, Milne N. Vertebral Artery Trauma. In: Rutty G, editor. Essentials of Autopsy Practice. Berlin: Springer; 2017. p. 23-41.

  5. Harland WA, Pitts JF, Watson AA. Subarachnoid haemorrhage due to upper cervical trauma. J Clin Path. 1983;36(12):1335–41.

    Article  CAS  PubMed  Google Scholar 

  6. Lee CK, Gray L, Maguire J. Traumatic vertebral artery injury: detailed clinicopathologic and morphometric analysis of 6 cases. Am J Forensic Med Pathol. 2009;30(2):134–6.

    Article  PubMed  Google Scholar 

  7. Kaiser C, Schnabel A, Berkefeld J, Bratzke H. Traumatic rupture of the intracranial vertebral artery due to rotational acceleration. Forensic Sci Int. 2008;182(1):e15–7. https://doi.org/10.1016/j.forsciint.2008.10.001.

    Article  PubMed  Google Scholar 

  8. Davis JM, Zimmerman RA. Injury of the carotid and vertebral arteries. Neuroradiol. 1983;25(2):55–69. https://doi.org/10.1007/bf00333294.

    Article  CAS  Google Scholar 

  9. Johnson CP, How T, Scraggs M, West CR, Burns J. A biomechanical study of the human vertebral artery with implications for fatal arterial injury. Forensic Sci Int. 2000;109(3):169–82. https://doi.org/10.1016/S0379-0738(99)00198-X.

    Article  CAS  PubMed  Google Scholar 

  10. Stemper BD, Yoganandan N, Sinson GP, Gennarelli TA, Stineman MR, Pintar FA. Biomechanical characterization of internal layer subfailure in blunt arterial injury. Ann Biomed Eng. 2007;35(2):285–91.

    Article  PubMed  Google Scholar 

  11. Pollanen MS, Deck JH, Blenkinsop B. Injury of the tunica media in fatal rupture of the vertebral artery. Am J Forensic Med Path. 1996;17(3):197–201.

    Article  CAS  Google Scholar 

  12. Farag AM, Franks A, Gee DJ. Simple laboratory experiments to replicate some of the stresses on vertebro-basilar arterial walls. An investigation of possible mechanisms of traumatic subarachnoid haemorrhage. Forensic Sci Int. 1988;38(3):275–84. https://doi.org/10.1016/0379-0738(88)90173-9.

  13. Blum CA, Yaghi S. Cervical artery dissection: A review of the epidemiology, pathophysiology, treatment, and outcome. Arch Neurosci. 2015;2(4):e26670. https://doi.org/10.5812/archneurosci.26670.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Park K-W, Park J-S, Hwang S-C, Im S-B, Shin W-H, Kim B-T. Vertebral artery dissection: natural history, clinical features and therapeutic considerations. J Korean Neurosurg Soc. 2008;44(3):109–15.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Morel A, Naggara O, Touzé E, Raymond J, Mas J-L, Meder J-F, et al. Mechanism of ischemic infarct in spontaneous cervical artery dissection. Stroke. 2012;43(5):1354–61.

    Article  PubMed  Google Scholar 

  16. Thomas LC, Rivett DA, Attia JR, Levi C. Risk factors and clinical presentation of cervical arterial dissection: preliminary results of a prospective case-control study. J Orthop Sports Phys Ther. 2015;45(7):503–11.

    Article  PubMed  Google Scholar 

  17. Tulyapronchote R, Selhorst JB, Malkoff MD, Gomez CR. Delayed sequelae of vertebral artery dissection and occult cervical fractures. Neurol. 1994;44(8):1397.

  18. Ben Hassen W, Machet A, Edjlali-Goujon M, Legrand L, Ladoux A, Mellerio C, et al. Imaging of cervical artery dissection. Diagn Interv Imaging. 2014;95(12):1151–61. https://doi.org/10.1016/j.diii.2014.10.003.

    Article  CAS  PubMed  Google Scholar 

  19. Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. New Eng J Med. 2001;344(12):898–906.

    Article  CAS  PubMed  Google Scholar 

  20. Opeskin K, Burke MP. Vertebral artery trauma. Am J Forensic Med Path. 1998;19(3):206–17.

    Article  CAS  Google Scholar 

  21. Moher D LA, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009;6(7):e1000097. https://doi.org/10.1371/journal.pmed1000097.

  22. Byrt T, Bishop J, Carlin JB. Bias, prevalence and kappa. J Clin Epi. 1993;46(5):423–9. https://doi.org/10.1016/0895-4356(93)90018-V.

    Article  CAS  Google Scholar 

  23. Potondi A, Rupnik P, Kapusz N. Injuries of the vertebral artery. J Forens Sci. 1966;11(3):395–403.

    CAS  Google Scholar 

  24. Marks RL, Freed MM. Nonpenetrating injuries of the neck and cerebrovascular accident. Arch Neurol. 1973;28(6):412–4.

    Article  CAS  PubMed  Google Scholar 

  25. Nagler W. Vertebral artery obstruction by hyperextension of the neck: report of three cases. Arch Phys Med Rehabil. 1973;54:237–40.

    CAS  PubMed  Google Scholar 

  26. Hanus SH, Homer TD, Harter DH. Vertebral artery occlusion complicating yoga exercises. Arch Neurol. 1977;34(9):574–5.

    Article  CAS  PubMed  Google Scholar 

  27. Ringel SP, Harrison SH, Norenberg MD, Austin JH. Fibromuscular dysplasia: multiple “spontaneous” dissecting aneurysms of the major cervical arteries. Ann Neurol. 1977;1(3):301–4.

    Article  CAS  PubMed  Google Scholar 

  28. Sorensen BF. Bow Hunter’s stroke. Neurosurg. 1978;2(3):259–61.

    Article  CAS  Google Scholar 

  29. Rogers L, Sweeney PJ. Stroke: a neurologic complication of wrestling: A case of brainstem stroke in a 17-year-old athlete. Am J Sports Med. 1979;7(6):352–4.

    Article  CAS  PubMed  Google Scholar 

  30. Bose B, Northrup BE, Osterholm JL. Delayed vertebro-basilar insufficiency following cervical spine injury. Spine. 1985;10(1):108–10.

    Article  CAS  PubMed  Google Scholar 

  31. Tramo MJ, Hainline B, Petito F, Lee B, Caronna J. Vertebral artery injury and cerebellar stroke while swimming: case report. Stroke. 1985;16(6):1039–42.

    Article  CAS  PubMed  Google Scholar 

  32. Lewis DW, Berman PH. Vertebral artery dissection and alternating hemiparesis in an adolescent. Pediatr. 1986;78(4):610–3.

    CAS  Google Scholar 

  33. Pryse-Phillips W. Infarction of the medulla and cervical cord after fitness exercises. Stroke. 1989;20(2):292–4.

    Article  CAS  PubMed  Google Scholar 

  34. Chang C, Ng H, Leung S, Fong K, Yu Y. Fatal bilateral vertebral artery dissection in a patient with cystic medial necrosis. Clin Neurol Neurosurg. 1991;93(4):309–11.

    Article  CAS  PubMed  Google Scholar 

  35. Hinse P, Thie A, Lachenmayer L. Dissection of the extracranial vertebral artery: report of four cases and review of the literature. J Neurol Neurosurg Psych. 1991;54(10):863–9.

    Article  CAS  Google Scholar 

  36. Schwarz N, Buchinger W, Gaudernak T, Russe F, Zechner W. Injuries to the cervical spine causing vertebral artery trauma. J Trauma. 1991;31(1):127–33.

    Article  CAS  PubMed  Google Scholar 

  37. Garg BP, Ottinger C, Smith R, Fishman M. Strokes in children due to vertebral artery trauma. Neurol. 1993;43(12):2555.

  38. Taniguchi A, Wako K, Naito Y, Kuzuhara S. Wallenberg syndrome and vertebral artery dissection probably due to trivial trauma during golf exercise. Rinsho Shinkeigaku. 1993;33(3):338–40.

    CAS  PubMed  Google Scholar 

  39. DeBehnke DJ, Brady W. Vertebral artery dissection due to minor neck trauma. J Emerg Med. 1994;12(1):27–31.

    Article  CAS  PubMed  Google Scholar 

  40. Lannuzel A, Moulin T, Amsallem D, Galmiche J, Rumbach L. Vertebral-artery dissection following a judo session: a case report. Neuroped. 1994;25(2):106–8.

    Article  CAS  Google Scholar 

  41. Sheth RD, Jaynes M, Gingold M, Ortiz O, Bodensteiner JB. Stroke due to a traumatic vertebral artery dissection in a girl. Clin Ped. 1994;33(8):503–6.

    Article  CAS  Google Scholar 

  42. Takakuwa T, Hiroi S, Hasegawa H, Hurukawa K, Endo S, Shimamura T. Os odontoideum with vertebral artery occlusion. Spine. 1994;19(4):460–2.

    Article  CAS  PubMed  Google Scholar 

  43. Willis BK, Greiner F, Orrison WW, Benzel EC. The incidence of vertebral artery injury after midcervical spine fracture or subluxation. Neurosurg. 1994;34(3):435–42.

    Article  CAS  Google Scholar 

  44. Fletcher J, Davies P, Lewis T, Campbell M. Traumatic carotid and vertebral artery dissection in a professional jockey: a cautionary tale. 1995;29(2):143–4.

    CAS  Google Scholar 

  45. Provenzale JM, Barboriak DP, Taveras JM. Exercise-related dissection of craniocervical arteries: CT, MR, and angiographic findings. J Comput Assist Tomogr. 1995;19(2):268–76.

    Article  CAS  PubMed  Google Scholar 

  46. Wirbel R, Pistorius G, Braun C, Eichler A, Mutschler W. Bilateral vertebral artery lesion after dislocating cervical spine trauma: a case report. Spine. 1996;21(11):1375–9.

    Article  CAS  PubMed  Google Scholar 

  47. Tekin S, Aykut-Bingöl C, Aktan S. Case of intracranial vertebral artery dissection in young age. Pediatr Neurol. 1997;16(1):67–70.

    Article  CAS  PubMed  Google Scholar 

  48. Sahjpaul RL, Abdulhak MM, Drake CG, Hammond RR. Fatal traumatic vertebral artery aneurysm rupture. J Neurosurg. 1998;89(5):822–4.

    Article  CAS  PubMed  Google Scholar 

  49. Jeerakathil T, Shuaib A. Vertebral dissection following golf. Can J Neurol Sci. 1999;S1:S63.

    Google Scholar 

  50. Griewing B, Brassel F, Schlesinger S, Schminke V, Kessler C. Vertebral artery stenting in an aneurysm after dissection. Radiogr. 2000;6(1):51–4. https://doi.org/10.1053/radi.1999.0227.

    Article  Google Scholar 

  51. Karnik R, Rothmund T, Bonner G, Valentin A, Reuther G. Inline skating as a possible cause of consecutive bilateral vertebral artery dissection. Acta Neurol Scand. 2000;101(1):70–1. https://doi.org/10.1034/j.1600-0404.2000.00010.x.

    Article  CAS  PubMed  Google Scholar 

  52. McCrory P. Vertebral artery dissection causing stroke in sport. J Clin Neurosci. 2000;7(4):298–300. https://doi.org/10.1054/jocn.1999.0189.

    Article  CAS  PubMed  Google Scholar 

  53. McCrory PR, Berkovic SF, Cordner SM. Deaths due to brain injury among footballers in Victoria, 1968-1999. Med J Aust. 2000;172(5):217–9.

    Article  CAS  PubMed  Google Scholar 

  54. Malek AM, Halbach VV, Phatouros CC, Meyers PM, Dowd CF, Higashida RT. Endovascular treatment of a ruptured intracranial dissecting vertebral aneurysm in a kickboxer. J Trauma Acute Care Surg. 2000;48(1):143.

    Article  CAS  Google Scholar 

  55. Konno K, Kurita H, Ito N, Shiokawa Y, Saito I. Extracranial vertebral artery dissection caused by scuba diving. J Neurol. 2001;248(9):816–7. https://doi.org/10.1007/s004150170102.

    Article  CAS  PubMed  Google Scholar 

  56. Matsushige T, Kurisu K, Arita K, Kiura Y, Yamasaki F, Shibukawa M, et al. A case of a vertebral dissecting aneurysm initially manifesting as ischemic stroke and secondary subarachnoid hemorrhage. Jpn J Neurosurg. 2001;10(10):682–7.

    Article  Google Scholar 

  57. Wechsler B, Kim H, Hunter J. Trampolines, children, and strokes. Am J Phys Med Rehab. 2001;80(8):608–13.

    Article  CAS  Google Scholar 

  58. Nishioka T, Maeda Y, Tomogane Y, Nakano A, Arita N. Unexpected delayed rupture of the vertebral–posterior inferior cerebellar artery aneurysms following closed head injury. Acta Neurochir. 2002;144(8):839–45. https://doi.org/10.1007/s00701-002-0952-3.

    Article  CAS  PubMed  Google Scholar 

  59. Maron BJ, Poliac LC, Ashare AB, Hall WA. Sudden death due to neck blows among amateur hockey players. JAMA. 2003;290(5):599–601. https://doi.org/10.1001/jama.290.5.599.

    Article  PubMed  Google Scholar 

  60. Watanabe-Suzuki K, Suzuki O, Nozawa H, Kosugi I, Ishii A. Traumatic basal subarachnoid haemorrhage caused by the impact of a golf ball. Med Sci Law. 2003;43(2):174–8.

    Article  PubMed  Google Scholar 

  61. De Giorgio F, Vetrugno G, De Mercurio D, Pascali VL, Rainio J, Carbone A, et al. Dissection of the vertebral artery during a basketball game: a case report. Med Sci Law. 2004;44(1):80–6.

    Article  PubMed  Google Scholar 

  62. Jörger G, Thielemann F. Traumatische Vertebralisdissektion bei einem 8-Jährigen. Unfallchirurg. 2004;107(9):803–6. https://doi.org/10.1007/s00113-004-0797-8.

    Article  PubMed  Google Scholar 

  63. Guptha SH, Promnitz AD, Warner A, Baron JC. A ‘collapsing’ golfer. Cerebrovasc Dis. 2005;19(4):281–2.

    Article  PubMed  Google Scholar 

  64. Maroon JC, Gardner P, Abla AA, El-Kadi H, Bost J. “Golfer’s stroke”: golf-induced stroke from vertebral artery dissection. Surg Neurol. 2007;67(2):163–8. https://doi.org/10.1016/j.surneu.2006.03.045.

    Article  PubMed  Google Scholar 

  65. Kawakami Y, Koizumi S-y, Kuwabara K, Fujimura J, Shirai J, Watanabe M et al. An 8-year-old boy with vertebral artery dissection with cerebellar ataxia featuring suspected vertebral artery hypoplasia. Brain Dev. 2009;31(4):326–30. https://doi.org/10.1016/j.braindev.2008.07.004.

  66. Cohen JE, Margolin E, Moscovici S, Paldor I, Itshayek E. Life-threatening massive subarachnoid hemorrhage after Taekwondo-associated head trauma. IMAJ. 2010;12(8):509–10.

    PubMed  Google Scholar 

  67. Keilani ZM, Berne JD, Agko M. Bilateral internal carotid and vertebral artery dissection after a horse-riding injury. J Vasc Surg. 2010;52(4):1052–7. https://doi.org/10.1016/j.jvs.2010.05.065.

    Article  PubMed  Google Scholar 

  68. Sepelyak K, Gailloud P, Jordan LC. Athletics, minor trauma, and pediatric arterial ischemic stroke. Eur J Ped. 2010;169(5):557–62. https://doi.org/10.1007/s00431-009-1066-1.

    Article  Google Scholar 

  69. Slankamenac P, Jesic A, Avramov P, Zivanovic Z, Covic S, Till V. Multiple cervical artery dissection in a volleyball player. Arch Neurol. 2010;67(8):1024. https://doi.org/10.1001/archneurol.2010.160.

  70. Davies SR. A rare complication of a unilateral vertebral artery occlusion, which resulted in a basilar emboli after a C5–C6 bifacet dislocation in a professional rugby player: case study. Spine J. 2011;11(3):e1–4. https://doi.org/10.1016/j.spinee.2011.01.030.

    Article  PubMed  Google Scholar 

  71. Johnson CR, Lavallee ME. Disequilibrium in an amateur mixed martial artist. Clin J Sport Med. 2011;21(2):182.

    Google Scholar 

  72. Low A, Dovey J, Ash-Miles J. Vertebral artery dissection in weightlifter with performance enhancing drug use. BMJ Case Rep. 2011;2011:bcr0920114768. https://doi.org/10.1136/bcr.09.2011.4768.

  73. Rizzone KH, Connor DJ, Gregory A. Think fast: sudden monocular vision loss in a basketball player. Clin J Sport Med. 2012;22(2):204.

    Google Scholar 

  74. Slowey M, Maw G, Furyk J. Case report on vertebral artery dissection in mixed martial arts. Emerg Med Australas. 2012;24(2):203–6. https://doi.org/10.1111/j.1742-6723.2011.01496.x.

    Article  PubMed  Google Scholar 

  75. Lai JC, Fletcher AS. Always wear a swim cap: a female swimmer with neck pain. Clin J Sport Med. 2013;23(2):e3–4.

    Google Scholar 

  76. Osawa A, Maeshima S, Maruyama H, Takeda H, Tanahashi N. Late-onset dysphagia in a sumo wrestler after a sumo bout. Curr Sports Med Rep. 2013;12(1):11–3. https://doi.org/10.1249/JSR.0b013e31827dc1c8.

    Article  PubMed  Google Scholar 

  77. Choi M, Hong J, Lee J, Shin D, Choi H, Lee K. Preferential location for arterial dissection presenting as golf-related stroke. Am J Neuroradiol. 2014;35(2):323–6.

    Article  CAS  PubMed  Google Scholar 

  78. Chojdak-Lukasiewicz J, Dziadkowiak E, Bladowska J, Paradowski B. Vertebral artery dissection and stroke after scuba diving. Neurol India. 2014;62(6):711.

    Article  PubMed  Google Scholar 

  79. Frankowska E, Brzozowski K, Staszewski J, Kolmaga N, Stępień A, Bogusławska-Walecka R. Combined thrombolysis in posterior circulation stroke caused by bilateral vertebral artery dissection in squash player. Neurol Neurochir Pol. 2014;48(4):299–304. https://doi.org/10.1016/j.pjnns.2014.07.010.

    Article  PubMed  Google Scholar 

  80. Pacei FV, Luca; Bet, Luciano. Vertebral artery dissection during Kung-Fu training. Neurol Sci. 2014;35(2):331–2.

  81. Pröscholdt F, Heining S, Powerski M, Nolte CH, Ertel W. Traumatic dissection of four brain-supplying arteries without neurologic deficit. Global Spine J. 2014;4(3):187–90. https://doi.org/10.1055/s-0034-1366972.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Tokumoto K, Ueda N. Cervical cord infarction associated with unilateral vertebral artery dissection due to golf swing. Rinsho Shinkeigaku. 2014;54(2):151–7. https://doi.org/10.5692/clinicalneurol.54.151.

    Article  PubMed  Google Scholar 

  83. Yamada SM, Goto Y, Murakami M, Hoya K, Matsuno A. Vertebral artery dissection caused by swinging a golf club: case report and literature review. Clin J Sport Med. 2014;24(2):155–7. https://doi.org/10.1097/01.jsm.0000432859.64058.d7.

    Article  PubMed  Google Scholar 

  84. Pumberger M, Druschel C, Disch AC. Transposition of the vertebral artery after a unilateral C1 lateral mass fracture: a case report and review of the literature. Clin J Sport Med. 2015;25(3):e59–61. https://doi.org/10.1097/jsm.0000000000000140.

    Article  PubMed  Google Scholar 

  85. Fragoso YD, Adoni T, do Amaral LL, Braga FT, Brooks JB, Campos CS et al. Cerebrum-cervical arterial dissection in adults during sports and recreation. Arquivos de neuro-psiquiatria. 2016;74(4):275–9. https://doi.org/10.1590/0004-282x20150150.

  86. Kageyama H, Yoshimura S, Iida T, Shirakawa M, Uchida K, Tomogane Y, et al. Juvenile Cerebral infarction caused by Bow Hunter’s syndrome during sport: two case reports. Neurol Med Chir. 2016;56(9):580–3. https://doi.org/10.2176/nmc.cr.2015-0351.

    Article  Google Scholar 

  87. Mas Rodriguez MF, Berrios RA, Ramos E. Spontaneous bilateral vertebral artery dissection during a basketball game: a case report. Sports Health. 2016;8(1):53–6. https://doi.org/10.1177/1941738114547347.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Bhattarai S, Elson W, Pradhan R, Pandey P. Cervical artery dissection at high altitude: an overview of two patients. J Travel Med. 2017;24(1):taw067-taw. https://doi.org/10.1093/jtm/taw067.

    Article  Google Scholar 

  89. Schaaf S, Stepanczuk B. Vertebral artery dissection and stroke in a female marathon runner: a case report. PM&R. 2017;9(9):S220–1.

    Article  Google Scholar 

  90. Aljishi M, Jayathissa S. Neurogenic pulmonary oedema secondary to vertebral artery dissection while playing tennis. BMJ Case Rep. 2018. https://doi.org/10.1136/bcr-2017-221753.

  91. Do KH, Leggit JC, Galifianakis A. Extracranial vertebral artery dissecting aneurysm with snowboarding: a case report. Curr Sports Med Rep. 2018;17(1):16–9. https://doi.org/10.1249/jsr.0000000000000441.

    Article  PubMed  Google Scholar 

  92. Suzuki S, Tsuchimochi R, Abe G, Yu I, Inoue T, Ishibashi H. Traumatic vertebral artery dissection in high school rugby players: a report of two cases. J Clin Neurosci. 2018;47:137–9. https://doi.org/10.1016/j.jocn.2017.10.008.

    Article  PubMed  Google Scholar 

  93. Florence A, Park D. A case of vertebral artery dissection and cerebellar infarct in the setting of concussion in a collegiate football player. Pediatr. 2018;142(1):413. https://doi.org/10.1542/peds.142.1_meetingabstract.413.

  94. Dittrich R, Rohsbach D, Heidbreder A, Heuschmann P, Nassenstein I, Bachmann R, et al. Mild mechanical traumas are possible risk factors for cervical artery dissection. Cerebrovasc Dis. 2007;23(4):275–81.

    Article  CAS  PubMed  Google Scholar 

  95. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S, et al. Cervical artery dissection: trauma and other potential mechanical trigger events. Neurol. 2013;80(21):1950–7.

    Article  Google Scholar 

  96. Koszyca B, Gilbert JD, Blumbergs PC. Traumatic subarachnoid hemorrhage and extracranial vertebral artery injury: a case report and review of the literature. Am J Forensic Med Path. 2003;24(2):114–8.

    Google Scholar 

  97. Nibu K, Cholewicki J, Panjabi M, Babat L, Grauer J, Kothe R, et al. Dynamic elongation of the vertebral artery during an in vitro whiplash simulation. Eur Spine J. 1997;6(4):286–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  98. Haldeman S, Kohlbeck FJ, McGregor M. Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation. Spine. 1999;24(8):785–94.

    Article  CAS  PubMed  Google Scholar 

  99. Johnson C, Baugh R, Wilson C, Burns J. Age related changes in the tunica media of the vertebral artery: implications for the assessment of vessels injured by trauma. 2001;54(2):139–45.

    CAS  Google Scholar 

  100. Debette S, Compter A, Labeyrie M-A, Uyttenboogaart M, Metso TM, Majersik JJ, et al. Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection. Lancet Neurol. 2015;14(6):640–54.

    Article  PubMed  Google Scholar 

  101. Völker W, Besselmann M, Dittrich R, Nabavi D, Konrad C, Dziewas R, et al. Generalized arteriopathy in patients with cervical artery dissection. Neurol. 2005;64(9):1508–13.

    Article  Google Scholar 

  102. Pickup MJ, Pollanen MS. Traumatic subarachnoid hemorrhage and the COL3A1 gene: emergence of a potential causal link. Forensic Sci Med Path. 2011;7(2):192–7. https://doi.org/10.1007/s12024-010-9205-6.

    Article  Google Scholar 

  103. Schievink W, Wijdicks E, Michels V, Vockley J, Godfrey M. Heritable connective tissue disorders in cervical artery dissections: a prospective study. Neurol. 1998;50(4):1166–9.

    Article  CAS  Google Scholar 

  104. Völker W, Dittrich R, Grewe S, Nassenstein I, Csiba L, Herczeg L, et al. The outer arterial wall layers are primarily affected in spontaneous cervical artery dissection. Neurol. 2011;76(17):1463–71.

    Article  Google Scholar 

  105. Paciaroni M, Georgiadis D, Arnold M, Gandjour J, Keseru B, Fahrni G, et al. Seasonal variability in spontaneous cervical artery dissection. J Neurol Neurosurg Psych. 2006;77(5):677–9. https://doi.org/10.1136/jnnp.2005.077073.

    Article  CAS  Google Scholar 

  106. Gray JT, Puetz SM, Jackson SL, Green MA. Traumatic subarachnoid haemorrhage: a 10-year case study and review. Forensic Sci Int. 1999;105(1):13–23. https://doi.org/10.1016/S0379-0738(99)00113-9.

    Article  CAS  PubMed  Google Scholar 

  107. Contostavlos DL. Isolated basilar traumatic subarachnoid hemorrhage: an observer’s 25 year re-evaluation of the pathogenetic possibilities. Forensic Sci Int. 1995;73(1):61–74. https://doi.org/10.1016/0379-0738(95)01700-3.

    Article  CAS  PubMed  Google Scholar 

  108. Thomas LC, Rivett DA, Attia JR, Parsons M, Levi C. Risk factors and clinical features of craniocervical arterial dissection. Man Ther. 2011;16(4):351–6.

    Article  PubMed  Google Scholar 

  109. Brukner P, Gara TJ, Fortington LV. Traumatic cricket-related fatalities in Australia: a historical review of media reports. Med J Aust. 2018;208(6):261–4.

    Article  PubMed  Google Scholar 

  110. Plant JR, Butt JC. Laceration of vertebral artery. An historic boxing death. Am J Forensic Med Path. 1993;14(1):61–4.

  111. Presley JC, Wisniewski SJ, Laskowski ER. Ataxia and sensory changes in a football player after an episode of acute head and neck pain. Clin J Sport Med. 2015;25(2):e33–4.

    Google Scholar 

  112. Leadbeatter S. Extracranial vertebral artery injury—evolution of a pathological illusion? Forensic Sci Int. 1994;67(1):33–40. https://doi.org/10.1016/0379-0738(94)90409-X.

    Article  CAS  PubMed  Google Scholar 

  113. Wong B, Ong BB, Milne N. The source of haemorrhage in traumatic basal subarachnoid haemorrhage. J Forensic Leg Med. 2015;29:18–23.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Cricket Australia, 60 Jolimont St, Jolimont, VIC, Australia

    Anna E. Saw & Alex Kountouris

  2. Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) and School of Engineering, Edith Cowan University, Joondalup, WA, Australia

    Andrew S. McIntosh

  3. McIntosh Consultancy and Research, Sydney, NSW, Australia

    Andrew S. McIntosh

  4. University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, ACT, Australia

    Phil Newman & James E. Gaida

Authors
  1. Anna E. Saw
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  2. Andrew S. McIntosh
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  3. Alex Kountouris
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  4. Phil Newman
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  5. James E. Gaida
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Corresponding author

Correspondence to Anna E. Saw.

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Conflict of interest

Anna Saw, Andrew McIntosh, Alex Kountouris, Phil Newman and James Gaida declare that they have no conflicts of interest.

Funding

This research was financially supported by Jardine Lloyd Thompson (JLT) Pty Ltd; however, JLT had no role in the conduct of this review or preparation of this manuscript.

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Saw, A.E., McIntosh, A.S., Kountouris, A. et al. Vertebral Artery Dissection in Sport: A Systematic Review. Sports Med 49, 553–564 (2019). https://doi.org/10.1007/s40279-019-01066-0

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