Left Internal Carotid Artery Dissection Secondary to Minor Trauma: A Case Report Involving "Headbanging" in a Heavy Metal Band.

Abstract

Introduction: Internal carotid artery dissection (ICAD) is an uncommon but clinically significant cause of ischemic stroke in young adults, accounting for approximately 10%-25% of cases in this population. It is frequently associated with minor trauma or repetitive cervical movements. Headbanging, characteristic of heavy metal music performances, involves vigorous, repetitive movements of the head and neck and may increase the risk of cervical vascular injury, including ICAD.

Case report: A 37-year-old male musician with no prior neurological disease presented with severe headache and transient focal neurological symptoms following heavy metal performances involving headbanging. On examination, blood pressure was 130/80 mmHg, and no focal neurological deficits were observed (NIHSS score: 0). Computed tomography angiography demonstrated a subocclusive thrombus involving the distal cervical and petrous segments of the left internal carotid artery, with distal hypoperfusion. Digital subtraction angiography subsequently confirmed a left ICAD of the petrous segment with approximately 80% luminal stenosis. Management included anticoagulation with dabigatran, strict blood pressure control, and multidisciplinary follow-up, including psychological support. The patient was discharged with guidance to avoid abrupt cervical movements and to continue regular outpatient and imaging follow-up.

Discussion: Although uncommon, the association between headbanging and ICAD warrants consideration in young patients presenting with ischemic stroke in the absence of traditional cardiovascular risk factors. Repetitive, forceful cervical movements may cause arterial wall injury, predisposing to dissection. Early diagnosis is essential to guide appropriate management and prevent complications.

Conclusion: This case highlights the importance of recognizing activities involving repetitive, vigorous cervical movements, such as headbanging, as potential etiological factors for arterial dissection in young adults. The absence of follow-up imaging is a limitation of this case report; nonetheless, it remains useful in raising awareness that may facilitate earlier diagnosis and improve clinical outcomes.