J Cerebrovasc Endovasc Neurosurg.  2017 Jun;19(2):111-116. 10.7461/jcen.2017.19.2.111.

Internal Carotid Artery Dissection in Brazilian Jiu-Jitsu

• Demartini
• Rodrigues Freire M
• Lages RO
• Francisco
• Nanni F
• Maranha Gatto LA
• Koppe GL

• KMID: 2393389
• DOI: http://doi.org/10.7461/jcen.2017.19.2.111

Abstract

Carotid artery dissection is a significant cause of stroke in young patients. It may be asymptomatic and go undiagnosed, or minimal transient manifestations may follow, commanding a higher index of suspicion than ordinarily exists to avoid misdiagnosis. Reported herein is a 27-year-old man who suffered extracranial internal carotid artery dissection while practicing a Brazilian Jiu-Jitsu submission maneuver. The patient's condition suddenly deteriorated one week later due to distal embolization and stroke. Despite endovascular treatment, with stenting of the cervical carotid artery, neurologic deficits remained. Of note, the objective in martial arts, which is to kill or incapacitate, has yet to be fully tempered in transitioning to sport. Brazilian Jiu-jitsu, a relatively new and fast-growing form of martial art, places emphasis on submission maneuvers. Related injuries are not common knowledge and are poorly described in the literature. This account is intended to shed light on the risk of this discipline. Through education and improved supervision, vascular injuries of this nature and the potentially lethal or disabling consequences may thus be prevented in young athletes.

Keyword

Carotid artery injuries; Internal carotid artery dissection; Endovascular treatment; Vascular disorder; Sports; Martial arts

MeSH Terms

Adult
Athletes
Carotid Arteries
Carotid Artery Injuries
Carotid Artery, Internal*
Carotid Artery, Internal, Dissection*
Diagnostic Errors
Education
Humans
Martial Arts
Neurologic Manifestations
Organization and Administration
Sports
Stents
Stroke
Vascular System Injuries

Figure

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  Fig. 1 Computed tomography scan imaging: (A) at emergency admission, showing hypodensity of left cerebral hemisphere after “windowing and leveling” and (B) at postoperative cranioplasty (B).

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  Fig. 2 Cerebral angiogram: (A) anteroposterior view of occluded M2 middle cerebral artery segments (arrows); (B) left common carotid artery in lateral view, showing narrowing at internal carotid artery origin (arrows); (C) stent placement; and (D) postoperative control images confirming adequate arterial patency, with mural compression of thrombus.

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  Fig. 3 Artistic rendering of Brazilian Jiu-Jitsu maneuver known as Rear Naked Choke or Lion Killer: combined neck extension and head rotation (as a defense measure) stretches the compressed internal carotid artery at its origin, causing dissection.

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