Case Presentation: A healthy 18-year-old male presented to the emergency department with headache, confusion, projectile vomiting, blurring of vision, and gait imbalance which he developed three days prior while working out at the gym doing “shoulder shrugs”. Imaging revealed a large evolving acute left cerebellar infarct with obstructive hydrocephalus and vertebral artery dissection at the level of the V3 segment. Neurosurgery was consulted but no surgical intervention was recommended. Treatment with aspirin was initiated. A repeat computed tomography of the head on the fifth day of admission showed moderately improved obstructive hydrocephalus secondary to a large evolving subacute left cerebellar infarct. The patient’s medical condition was back to baseline and he was discharged with aspirin and was recommended close follow-up with a neurologist in the outpatient setting.
Discussion: Arterial dissection occurs when blood enters the space between a blood vessel’s intima and media layers, either due to a spontaneous or traumatic breach. Vertebral artery dissection(VAD), with an incidence of 0.97 cases per 100,000 people, typically results from trauma or occurs spontaneously. Spontaneous VAD in young individuals is rare. Our case developed cerebellar stroke due to VAD during shoulder exercise at the gym without any direct trauma. Patients typically experience symptoms such as neck pain, headaches, visual disturbances, or focal extremity weakness. The dissection leads to thrombus formation, hypoperfusion, thromboembolism, and subsequent strokes. Accurate diagnosis is crucial, with CT angiography being more sensitive than Doppler ultrasound. Arteriography remains the gold standard. Anticoagulants constitute the primary treatment. However, both antiplatelet therapy and systemic antithrombotic therapy show comparable outcomes in recent studies when assessing the risk of stroke and rates of injury healing.
Conclusions: This case highlights the significance of recognizing unusual triggers for VAD, such as physical activities like shoulder shrugs. Early diagnosis and appropriate management are vital in preventing severe complications and ensuring a favorable outcome for patients with VAD, particularly in atypical demographic groups.