He then presented 2 weeks post injury with acute hemiplegia and was diagnosed with carotid dissection and underwent surgical intervention but developed and large left sided hemispheric infarct and expired 5 days post admission. This case series included trauma patients and highlighted the delayed nature of presentations of BCVI with new neurological deficits ascribed to the injuries occurring as late as 6 months post injury ATM/ATR inhibitor clinical trial . Similarly, a case series from Mayo Clinic of 18 patients 3 of which were sports related injuries, also noted a delay in presentation from 30 minutes to 10 years post injury . Within the pediatric literature there are individual case reports including a report of 3 American
football players 17, 15, and 17DMAG price 14 years of age who sustained cerebellar infarct, left pontine stroke, and left middle cerebral infarct respectively . These players all
had neurological findings and also presence of one or some of the following prothrombotic mutations: C188-9 clinical trial methylene tetrahydrofolate reductase gene variant C677T and A1298C, PAI 1-4G, prothrombin 20210. Additionally, there is a report of a 15 year old who developed symptoms during a game of American football without obvious trauma and presented to hospital with a progressive neurological deficit ascribed to a left ICA dissection with hemispheric infarct and an ultimately fatal course 4 days following admission . It is unclear from the case report whether or not he was playing. A review of 18 cases of sport-related BCVI (not including Rugby) were related to a wide range of activities including cycling, football, French boxing, Hockey, In-line Skating, Scuba diving, Skiing, Softball, Taekwondo, Weight lifting, and Wintersports . Pathophysiology was presumed to be due to a crush injury to the carotid with disruption to the intima in 62% of
patients with a subintimal dissection with internal carotid Uroporphyrinogen III synthase dissections carrying a more severe course and worse long term outcome. In a recent broad overview of BCVI etiology is thought to be stretch of the common carotid artery over C3-5 during extreme neck extension . The strokes that arise from these injuries are thought to be either embolic from dislodged clot from a focal site of intimal disruption or from dissection causing vessel occlusion or sufficient narrowing to result in cerebral infarct. Anatomic variation in the Circle of Willis, incomplete in 80% of the population, contributes to the severity of carotid occlusion by functionally making the internal carotid artery an end artery rather a collateralized artery. This fact is further corroborated from recent vascular surgery literature regarding 2 or more obstructions or agenesis within the Circle of Willis with inability to tolerate carotid cross clamping . Regarding our case the patient received a traumatic tackle while playing at scrum-half position (back) in a training scenario.