Carotid artery dissection and sports

Summary Carotid artery dissection (CAD) is a potentially lifethreatening disease and mainly affects young and middle-aged people. In recent years dissections have been diagnosed more frequently, probably because new imaging techniques allow more reliable diagnosis. The cause of so-called spontaneous CAD is largely unexplained. It most likely involves an underlying abnormality of the vessel wall and triggering factors such as infection, minor trauma or sporting activities. Various sporting activities have been reported in association with CAD. Nevertheless, the causal relationship between sporting activities and CAD often remains doubtful. Traumatic CAD mainly complicates severe blunt head or neck traumas, which are often due to motor vehicle or sport accidents. The clinical presentations of CAD are highly variable. Headache, neck and facial pain, pulsatile tinnitus, Horner’s syndrome, cranial nerve palsies, stroke, TIA, retinal infarction, or transient monocular blindness, may be present in isolation or in various combinations. Ischaemic symptoms are often preceded by local symptoms or signs. The knowledge and recognition of these symptoms and the often subtle signs are the keys to an early diagnosis and antithrombotic treatment of ICAD before severe ischaemic complications occur. The longterm prognosis of CAD is favourable in the majority of patients. Clinical functional outcome mainly depends on the initial stroke severity. Symptomatic recurrent dissections and recurrent strokes are rare.