Cervical Artery Dissection and Sports

Stefan T Engelter; Christopher Traenka; Caspar Grond-Ginsbach; Tobias Brandt; Maani Hakimi; Bradford B Worrall; Stephanie Debette; Alessandro Pezzini; Didier Leys; Turgut Tatlisumak; Christian H Nolte; Philippe Lyrer

doi:10.3389/fneur.2021.663830

Cervical Artery Dissection and Sports

Front Neurol. 2021 May 31:12:663830. doi: 10.3389/fneur.2021.663830. eCollection 2021.

Authors

Stefan T Engelter^{1

2}, Christopher Traenka^{1

2}, Caspar Grond-Ginsbach^{2

3}, Tobias Brandt⁴, Maani Hakimi⁵, Bradford B Worrall⁶, Stephanie Debette^{7

8}, Alessandro Pezzini⁹, Didier Leys¹⁰, Turgut Tatlisumak¹¹, Christian H Nolte¹², Philippe Lyrer¹

Affiliations

¹ Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
² Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland.
³ Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
⁴ Schweizerische Unfallversicherungsanstalt (SUVA), Swiss National Accident Insurance Institution, Lucerne, Switzerland.
⁵ Department of Vascular Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.
⁶ Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville, VA, United States.
⁷ Department of Neurology, Bordeaux University Hospital, Bordeaux, France.
⁸ Inserm U1219, Bordeaux, France.
⁹ Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy.
¹⁰ Univ-Lille, Inserm U1171, Centre Hospitalier Universitaire (CHU) Lille, Lille, France.
¹¹ Department of Neurology, Sahlgrenska University Hospital and Department of Clinical Neuroscience, Institute for Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
¹² Department of Neurology, and Center for Stroke Research Berlin Charité-Universitätsmedizin Berlin, Berlin, Germany.

Abstract

Cervical artery dissection (CeAD) occurring in the context of sports is a matter of concern for CeAD patients. They seek advice on the role of sports in CeAD and on the safety of resuming sports after CeAD. The scarcity of studies and guidelines addressing these issues poses a challenge. We aimed at summarizing the current knowledge about CeAD and sports in order to provide an informed, comprehensive opinion for counseling CeAD patients. We took into account pathophysiological considerations, observations of cases reports, series, and registries, and conclusions by analogy from aortic dissection or inherited connective tissue syndromes. In summary, practicing active sports as the cause of CeAD seems uncommon. It seems recommendable to refrain from any kind of sports activities for at least 1 month, which can be extended in case of an unfavorable clinical or neurovascular course. We recommend starting with sport activities at low intensity-preferably with types of endurance sports-and to gradually increase the pace in an individually tailored manner, taking into circumstances of the occurrences of the CeAD in the individual patient (particularly in relation to sports), the meaning of sports activities for the individual well-being, the presence or absence of comorbidities and of neurological sequela, neurovascular findings, and whether there are signs of an underlying connective tissue alteration. Major limitations and several forms of bias are acknowledged. Still, in the absence of any better data, the summarized observations and considerations might help clinicians in advising and counseling patients with CeAD in clinical practice.

Keywords: carotid artery dissection; cervical artery dissection; physical acitivity; sport; vertebral artery dissection.