A 47-year-old man presented with sudden onset of dysarthria and left-sided weakness while practicing golf on a driving range. His medical history was unremarkable. On examination, he was drowsy, had right gaze preference, and showed visual and tactile extinction of the left stimuli. He also showed left central facial palsy and left hemiparesis. Diffusion-weighted magnetic resonance imaging of the brain showed infarctions in the territory of the right middle cerebral artery (Figure, A and B). Cerebral angiography revealed dissection of the right internal carotid artery and occlusion of the right middle cerebral artery (Figure, C and D). There was no underlying defect in the dissecting artery, and the patency of other cerebral arteries was normal. He underwent stent-assisted angioplasty of the right internal carotid artery and subsequent intraarterial urokinase injection in the right middle cerebral artery. Remarkably, the patient recovered with only mild dysarthria within a week and was discharged home with a prescribed regimen of aspirin (325 mg) and clopidogrel (Plavix, 75 mg).
Choi K, Oh S, Yang T, Lee T. Golfer's Stroke From Internal Carotid Artery Dissection. Arch Neurol. 2008;65(8):1122-1123. doi:10.1001/archneur.65.8.1122