To the Editor.
—Dissection of the internal carotid artery may occur as the result of relatively trivial trauma, usually in the setting of sports activity.1 It is estimated that 41% of American adults exercise regularly outside of work,2 yet carotid artery dissection accounts for less than 1% of all cerebrovascular disease,1,2 suggesting that this is a rare or underreported problem.We have recently seen two cases of internal carotid dissection resulting in stroke in the middle cerebral artery territory, shortly after two different, commonly used, simple exercise programs.
Report of Cases.
—Case 1.—A 23-year-old right-handed woman, who had a history of common migraine headaches since the age of 13 years, suddenly developed severe right-sided headache and left-sided weakness while performing aerobic exercises in response to a popular exercise record. She had begun the exercise routine with the usual "warm-up" of flexion, hyperextension, and rotation of the neck
DeCarli C, Kurlan R, Green R. Exercise-Related Middle Cerebral Artery Territory Stroke. Arch Neurol. 1987;44(1):11–12. doi:10.1001/archneur.1987.00520130007003
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