Introduction Internal carotid artery dissection (ICAD) is an uncommon but clinically significant cause of ischemic stroke in young adults, accounting for approximately 10%–25% of cases in this population. It is frequently associated with minor trauma or repetitive cervical movements. Headbanging, characteristic of heavy metal music performances, involves vigorous, repetitive movements of the head and neck and may increase the risk of cervical vascular injury, including ICAD. Case Report A 37‐year‐old male musician with no prior neurological disease presented with severe headache and transient focal neurological symptoms following heavy metal performances involving headbanging. On examination, blood pressure was 130/80 mmHg, and no focal neurological deficits were observed (NIHSS score: 0). Computed tomography angiography demonstrated a subocclusive thrombus involving the distal cervical and petrous segments of the left internal carotid artery, with distal hypoperfusion. Digital subtraction angiography subsequently confirmed a left ICAD of the petrous segment with approximately 80% luminal stenosis. Management included anticoagulation with dabigatran, strict blood pressure control, and multidisciplinary follow‐up, including psychological support. The patient was discharged with guidance to avoid abrupt cervical movements and to continue regular outpatient and imaging follow‐up. Discussion Although uncommon, the association between headbanging and ICAD warrants consideration in young patients presenting with ischemic stroke in the absence of traditional cardiovascular risk factors. Repetitive, forceful cervical movements may cause arterial wall injury, predisposing to dissection. Early diagnosis is essential to guide appropriate management and prevent complications. Conclusion This case highlights the importance of recognizing activities involving repetitive, vigorous cervical movements, such as headbanging, as potential etiological factors for arterial dissection in young adults. The absence of follow‐up imaging is a limitation of this case report; nonetheless, it remains useful in raising awareness that may facilitate earlier diagnosis and improve clinical outcomes.
Background:Myocardial infarction with nonobstructive coronary arteries (MINOCA) accounts for a meaningful proportion of acute myocardial infarction presentations and encompasses heterogeneous mechanisms. Coronary microvascular dysfunction (CMD) is a major cause of MINOCA and can be invasively characterized using coronary physiology indices, including the index of microvascular resistance (IMR) and coronary flow reserve (CFR). Systemic sclerosis (SSc) is associated with small-vessel vasculopathy and may predispose individuals to CMD. However, MINOCA attributable to SSc-related CMD confirmed by invasive coronary function testing and cardiac magnetic resonance (CMR) is not widely reported. Case Presentation:A 76-year-old woman with SSc and interstitial pneumonia presented with persistent chest pain. Electrocardiography revealed new T-wave inversions in leads V1-V4, and echocardiography demonstrated mid-anterior left ventricular asynergy. Troponin T was elevated (0.206 ng/mL). Emergency coronary angiography showed no obstructive epicardial stenosis, but left ventriculography confirmed regional wall-motion abnormality. CMR demonstrated base-to-mid anteroseptal dysfunction with increased native T1, T2, and extracellular volume fraction, supporting MINOCA. Transient systemic inflammation was observed (peak C-reactive protein 14.69 mg/dL; white blood cell count 24,600/μL) without evidence of infection and it resolved spontaneously. Six weeks later, acetylcholine provocation testing was negative for epicardial spasm, but invasive physiological assessment identified CMD (IMR 30.5; CFR 1.7). The patient was treated with a calcium-channel blocker and nicorandil. At 3-month follow-up, symptoms, electrocardiographic changes, and CMR abnormalities normalized, which indicated a reverse of the ischemic injury. No recurrence occurred during 1 year of follow-up. Conclusion:SSc-associated MINOCA, possibly driven by CMD, was diagnosed by comprehensive invasive coronary function testing and CMR. Serial CMR may help to document reversibility of microvascular ischemic injury and guide vasodilator therapy and follow-up.
Congenital anomalies of the aortic arch often lead to tracheoesophageal compression during childhood. Occasionally, symptoms may not emerge until adulthood, appearing for the first time at any age due to age-related or pathological dilation of the aortic segments. The oldest patient described with symptoms at the onset was 76 years old. Surgical intervention is complex and poses challenges. This case study describes a patient with a right mirror-image branching aortic arch, Kommerell's diverticulum, and a ligamentum arteriosum originating from the diverticulum. The patient first experienced symptoms of tracheoesophageal compression at 57 years of age. Initial treatment at another hospital, which involved division of the ligamentum and incomplete resection of the diverticulum with its fixation to the chest wall, did not alleviate symptoms. Successful off-pump resurgery was performed through a sternotomy, which included complete resection of Kommerell's diverticulum and direct closure of the aorta without the use of a patch. Additionally, the left brachiocephalic artery was repositioned away from the tracheoesophageal complex. External skin surface cooling to 30°C-31°C in the esophagus facilitated safe clamping of the left brachiocephalic artery during the transfer. This case demonstrates successful exposure of Kommerell's diverticulum through sternotomy and the potential to avoid extracorporeal circulation during clamping of the brachiocephalic trunk by utilizing systemic hypothermia with external cooling.
We report a 36-year-old healthy woman with 2 days of right-sided blurry vision, headache, and pain with eye movement. Exam showed decreased visual acuity, focal retinal pallor, and abnormal cranial nerve II findings. CTA revealed right vertebral artery dissection at C5-C6 with concurrent ophthalmic artery narrowing. She received anticoagulation, intravenous steroids for optic neuritis, and improved with follow-up. This rare presentation underscores the need to consider cervical artery dissection in young patients with painful vision loss and subtle fundoscopic changes, as timely vascular imaging can reveal unexpected concurrent pathology.
