A 60-year-old man developed a disturbed consciousness and left hemiplegia following a judo chokehold. His opponent's arm probably compressed his right carotid artery for less than 1 minute. Brain computed tomography (CT) and diffusion-weighted magnetic resonance imaging showed right middle cerebral artery territory infarction (Picture 1, arrows). Filling defects and a thrombus were found in the right internal carotid artery (ICA) by CT angiography (Picture 2, 3 arrows) and ultrasonography (Picture 4A, asterisk), respectively. The thrombus disappeared 21 days later (Picture 4B). At discharge, his modified Rankin Scale score was 4.
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Picture 4.
ICA occlusion has not previously been reported in association with a chokehold. Extracranial carotid artery injury usually occurs beyond the bifurcation, where the lateral mass of the cervical vertebrae compresses the ICA (1). In our case, the history and neuroimaging findings strongly suggested local thrombosis arising from intimal disruption. Carotid artery injury must therefore be considered when a stroke occurs during contact sports.
The authors state that they have no Conflict of Interest (COI).
References
- 1. Fabian TC. Blunt cerebrovascular injuries: Anatomic and pathologic heterogeneity create management enigmas. J Am Coll Surg 216: 873-885, 2013. [DOI] [PubMed] [Google Scholar]