Hole in One: Golf-Associated Dissection

Cervical artery dissection (CeAD) causes ~20% of ischaemic strokes in people under 45 years old; and are associated with identifiable mechanical triggering events in ~40% of cases. Certain sports have been identified as risk factors for cervical arterial dissection, with different sports affecting anterior and posterior circulations preferentially. We report a case of a 46-year old man who developed a vertebral artery dissection within several hours of playing golf. Arterial dissections associated with golf show the strongest proclivity of all sports towards vertebral arteries (88%), that may be due to extreme cervical rotation during golf swings. By contrast, general exercise, weight training and scuba diving cause dissections in the carotid arteries preferentially. Our case was complicated by basilar artery occlusion, for which a thrombectomy was performed. Despite successful recanalization, a large posterior circulation infarction ensued that was untreatable and unfortunately fatal.