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Carotid Dissection Associated with a Handheld Electric Massager

Arthur C. Grant, MD, PHD, Norman Wang, MD
Volume: 97 Issue: 12 December, 2004

Abstract:

The extracranial internal carotid artery (ICA) is susceptible to injury and dissection from external shear forces applied to the neck. Traumatic ICA dissection usually occurs in the setting of a sudden, high amplitude force causing significant distortion of surrounding soft tissues. Weaker, repetitive forces applied for longer intervals may also pose a risk for ICA dissection. A 38-year-old woman with no significant stroke risk factors had sudden onset of severe dysarthria and left hemiparesis several days after receiving an approximately 20-minute neck massage with a handheld electric massager. The moving elements consisted of two approximately 2-cm-diameter spheres that percuss the skin with low amplitude and high frequency. Magnetic resonance imaging and angiography demonstrated acute infarction in the right middle cerebral artery territory and dissection of the extracranial right ICA. Handheld electric massager units may cause ICA dissection and disabling stroke.


Key Points


* A 38-year-old woman with no significant stroke risk factors had sudden onset of severe dysarthria and left hemiparesis several days after receiving an approximately 20-minute neck massage with a handheld electric massager.


* The moving elements consisted of two approximately 2-cm-diameter spheres that percuss the skin with low amplitude and high frequency.


* Magnetic resonance imaging and angiography demonstrated acute infarction in the right middle cerebral artery territory and dissection of the extracranial right internal carotid artery.


* Handheld electric massager units may cause internal carotid artery dissection and disabling stroke.

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References:

1. Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med2001;344:898–906.
 
2. Milhaud D, de Freitas GR, van Melle G, et al. Occlusion due to carotid artery dissection: a more severe disease than previously suggested. Arch Neurol 2002;59:557–561.
 
3. Fletcher J, Davies PT, Lewis T, et al. Traumatic carotid and vertebral artery dissection in a professional jockey: a cautionary tale. Br J Sports Med 1995;29:143–144.
 
4. Shievink WI, Atkinson JL, Bartleson JD, et al. Traumatic internal carotid artery dissections caused by blunt softball injuries. Am J Emerg Med 1998;16:179–182.
 
5. Peters M, Bohl J, Thömke F, et al. Dissection of the internal carotid artery after chiropractic manipulation of the neck. Neurology 1995;45:2284–2286.
 
6. Ernst E. Life-threatening complications of spinal manipulation. Stroke 2001;32:809–810.
 
7. Elliott MA, Taylor LP. “Shiatsu sympathectomy”: ICA dissection associated with a shiatsu massager.Neurology 2002;58:1302–1304.
 

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