Neurol Sci DOI 10.1007/s10072-014-1831-4
LETTER TO THE EDITOR
‘‘Head banging’’ causing subdural hemorrhage and internal carotid artery dissection Nicola Gilberti • Massimo Gamba • Roberto Gasparotti Alessandro Padovani • Mauro Magoni
•
Received: 4 March 2014 / Accepted: 8 May 2014 Ó Springer-Verlag Italia 2014
Introduction ‘‘Head banging’’ is the term used to describe a type of dance characterized by violent and rhythmic movement of flexion and extension of the neck synchronous with music. We report the case of a boy with subdural hemorrhage (SDH) and cerebral infarct associated with intracranial internal carotid artery dissection (ICAD), both occurred after ‘‘head banging’’.
Case A 16-year-old caucasian male presented at the emergency department with sudden onset of severe diffuse headache. He denied head or neck trauma, but reported ‘‘head banging’’ during a rock concert the evening before the onset of headache. Clinical examination at the emergency department revealed only mild drowsiness without focal signs. Brain computed tomography (CT) scan and magnetic resonance imaging (MRI), including MR Angiography (MRA), revealed a right-sided subdural hematoma (SDH) with slight shift of the midline structures. No underlying brain
N. Gilberti (&) M. Gamba M. Magoni Unita` Operativa di Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italy e-mail: [email protected] R. Gasparotti Dipartimento di Diagnostica per Immagini, Neuroradiologia, Universita` degli studi di Brescia, Brescia, Italy A. Padovani Clinica Neurologica, Universita` degli Studi di Brescia, Brescia, Italy
lesions were detected. MRA showed a mild narrowing of the supraclinoid segment of the right carotid siphon and of the proximal M1-MCA segment. Digital subtraction angiography (DSA) confirmed the MRA findings and also revealed a perfusion delay in the right MCA territory, therefore suggesting a dissection of the right carotid siphon and proximal M1-MCA (Fig. 1). Headache gradually regressed over a period of 1 week and the patient was then asymptomatic. One month follow-up brain CT and MRI showed partial resorption of SDH and the appearance of a right-sided cerebral infarct in the temporal and parietal lobes (Fig. 1); patient did not experience new symptoms and neurological examination was normal. DSA was repeated showing normal size of the right ICA and MCA. At the 90 days follow-up the patient was asymptomatic and brain CT scan revealed gradual resorption of SDH and chronic right-sided cerebral infarct.
Discussion Head banging is a relatively diffuse practice among adolescent and young adults while dancing at rock concerts. Recent reports have shown possible medical complications of this type of dance including cervical artery dissection (CAD) and SDH [1]. It is known that CAD can be associated with minor traumas, such as chiropractic manipulation and sporting activities [2]. Intracranial arterial dissection (IAD) is relatively rare compared to extracranial one. A few series revealed that IAD tends to be more frequently spontaneous even if some authors reported IAD related to sports or other leisure activities [3, 4].
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Neurol Sci
Fig. 1 a One month follow-up brain CT showed right-sided chronic subdural haematoma and cerebral infarct in the right temporal and parietal lobes. b Initial cerebral magnetic resonance angiography revealed a mild narrowing of the supraclinoid segment of the right
carotid siphon and of the proximal M1-MCA segment (white arrow). c–e Digital subtraction angiography: perfusion delay in the right MCA territory and mild narrowing of the supraclinoid internal carotid artery (black arrow)
SDH usually occurs secondary to direct trauma to the head from bridging vein rupture. Previews reports showed that rotational acceleration/deceleration or repetitive head movements can cause SDH without direct traumatic mechanism [5]. To our knowledge, there is no prior report of concomitant intracranial ICA dissection and SDH in a single subject, related to head banging. The absence of head or neck trauma and vascular abnormalities suggests that in our patient intracranial ICAD and SDH might be the direct result of ‘‘head banging’’. This case report seems to confirm that head banging might not be free of medical complications, even severe and potentially life-threatening.
References
123
1. Jackson MA, Hughes RC, Ward SP, McInnes EG (1983) ‘‘Headbanging’’ and carotid dissection. Br Med J 287:1262 2. Dittrich R, Rohsbach D, Heidbreder A, Heuschmann P, Nassenstein I, Bachmann R, Ringelstein EB, Kuhlenba¨umer G, Nabavi DG (2007) Mild mechanical traumas are possible risk factors for cervical artery dissection. Cerebrovasc Dis 23:275–281 3. Abe A, Nishiyama Y, Kamiyama H, Kitahara I, Katsura K, Katayama Y (2009) Symptomatic middle cerebral artery dissection in a young tennis player. J Nippon Med Sch 76:209–211 4. Iwanami H, Odaka M, Hirata K (2007) Bilateral cerebellar infarction caused by intracranial dissection of the vertebral artery after long periods of ‘‘Shiatsu’’. Brain Nerve 59:169–171 5. Depreitere B, Van Lierde C, Sloten JV, Van Audekercke R, Van der Perre G, Plets C, Goffin J (2006) Mechanics of acute subdural hematomas resulting from bridging vein rupture. J Neurosurg 104:950–956
LETTER TO THE EDITOR
‘‘Head banging’’ causing subdural hemorrhage and internal carotid artery dissection Nicola Gilberti • Massimo Gamba • Roberto Gasparotti Alessandro Padovani • Mauro Magoni
•
Received: 4 March 2014 / Accepted: 8 May 2014 Ó Springer-Verlag Italia 2014
Introduction ‘‘Head banging’’ is the term used to describe a type of dance characterized by violent and rhythmic movement of flexion and extension of the neck synchronous with music. We report the case of a boy with subdural hemorrhage (SDH) and cerebral infarct associated with intracranial internal carotid artery dissection (ICAD), both occurred after ‘‘head banging’’.
Case A 16-year-old caucasian male presented at the emergency department with sudden onset of severe diffuse headache. He denied head or neck trauma, but reported ‘‘head banging’’ during a rock concert the evening before the onset of headache. Clinical examination at the emergency department revealed only mild drowsiness without focal signs. Brain computed tomography (CT) scan and magnetic resonance imaging (MRI), including MR Angiography (MRA), revealed a right-sided subdural hematoma (SDH) with slight shift of the midline structures. No underlying brain
N. Gilberti (&) M. Gamba M. Magoni Unita` Operativa di Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italy e-mail: [email protected] R. Gasparotti Dipartimento di Diagnostica per Immagini, Neuroradiologia, Universita` degli studi di Brescia, Brescia, Italy A. Padovani Clinica Neurologica, Universita` degli Studi di Brescia, Brescia, Italy
lesions were detected. MRA showed a mild narrowing of the supraclinoid segment of the right carotid siphon and of the proximal M1-MCA segment. Digital subtraction angiography (DSA) confirmed the MRA findings and also revealed a perfusion delay in the right MCA territory, therefore suggesting a dissection of the right carotid siphon and proximal M1-MCA (Fig. 1). Headache gradually regressed over a period of 1 week and the patient was then asymptomatic. One month follow-up brain CT and MRI showed partial resorption of SDH and the appearance of a right-sided cerebral infarct in the temporal and parietal lobes (Fig. 1); patient did not experience new symptoms and neurological examination was normal. DSA was repeated showing normal size of the right ICA and MCA. At the 90 days follow-up the patient was asymptomatic and brain CT scan revealed gradual resorption of SDH and chronic right-sided cerebral infarct.
Discussion Head banging is a relatively diffuse practice among adolescent and young adults while dancing at rock concerts. Recent reports have shown possible medical complications of this type of dance including cervical artery dissection (CAD) and SDH [1]. It is known that CAD can be associated with minor traumas, such as chiropractic manipulation and sporting activities [2]. Intracranial arterial dissection (IAD) is relatively rare compared to extracranial one. A few series revealed that IAD tends to be more frequently spontaneous even if some authors reported IAD related to sports or other leisure activities [3, 4].
123
Neurol Sci
Fig. 1 a One month follow-up brain CT showed right-sided chronic subdural haematoma and cerebral infarct in the right temporal and parietal lobes. b Initial cerebral magnetic resonance angiography revealed a mild narrowing of the supraclinoid segment of the right
carotid siphon and of the proximal M1-MCA segment (white arrow). c–e Digital subtraction angiography: perfusion delay in the right MCA territory and mild narrowing of the supraclinoid internal carotid artery (black arrow)
SDH usually occurs secondary to direct trauma to the head from bridging vein rupture. Previews reports showed that rotational acceleration/deceleration or repetitive head movements can cause SDH without direct traumatic mechanism [5]. To our knowledge, there is no prior report of concomitant intracranial ICA dissection and SDH in a single subject, related to head banging. The absence of head or neck trauma and vascular abnormalities suggests that in our patient intracranial ICAD and SDH might be the direct result of ‘‘head banging’’. This case report seems to confirm that head banging might not be free of medical complications, even severe and potentially life-threatening.
References
123
1. Jackson MA, Hughes RC, Ward SP, McInnes EG (1983) ‘‘Headbanging’’ and carotid dissection. Br Med J 287:1262 2. Dittrich R, Rohsbach D, Heidbreder A, Heuschmann P, Nassenstein I, Bachmann R, Ringelstein EB, Kuhlenba¨umer G, Nabavi DG (2007) Mild mechanical traumas are possible risk factors for cervical artery dissection. Cerebrovasc Dis 23:275–281 3. Abe A, Nishiyama Y, Kamiyama H, Kitahara I, Katsura K, Katayama Y (2009) Symptomatic middle cerebral artery dissection in a young tennis player. J Nippon Med Sch 76:209–211 4. Iwanami H, Odaka M, Hirata K (2007) Bilateral cerebellar infarction caused by intracranial dissection of the vertebral artery after long periods of ‘‘Shiatsu’’. Brain Nerve 59:169–171 5. Depreitere B, Van Lierde C, Sloten JV, Van Audekercke R, Van der Perre G, Plets C, Goffin J (2006) Mechanics of acute subdural hematomas resulting from bridging vein rupture. J Neurosurg 104:950–956
