A 25-year-old man suffered a stroke due to stretching during a fitness class before his wedding. Can he still do stretching and neck massage in fitness class?

Recently, a 25-year-old man suffered a stroke due to stretching in a fitness class after "surprise muscle training" before his wedding, which became a hot topic on the Internet. A month before his wedding, a 25-year-old man in Shenzhen went to the gym for a "surprise muscle training". However, in his first fitness class, his personal trainer gave him a "crazy" stretching. After the class, he felt dizzy and had frequent nausea and vomiting. In the end, he was diagnosed with a stroke caused by "bilateral vertebral artery dissection". The doctor restored blood supply to the brain through thrombolysis and interventional surgery.

Gyms are now everywhere. If you stretch crazily in the gym, you will suffer from "bilateral vertebral artery dissection" and cause a stroke. When it comes to massage, I believe many people are familiar with it. After being tired from work, getting a massage after traveling to relax has become the norm for urban people nowadays. In the streets and alleys, there is a health regimen every five steps and a foot massage every ten steps. The massage industry is very popular. Tuina massage is also a method of relieving muscle fatigue with a long history in my country. There are also young people who have suffered strokes after massage.

It turns out that cerebral infarction is not exclusive to the elderly. In addition to underlying diseases (such as high blood pressure, high blood sugar, high blood lipids), smoking and drinking and other risk factors, arterial dissection is also one of the causes of ischemic stroke. As people's concept of "massage for health" becomes stronger, stroke after cervical artery dissection has also begun to appear in healthy young and middle-aged people.

1. Can we still do stretching and neck massage?

Where should you not press a massage? It should be the neck! Some people have a misunderstanding about massage: the harder the force, the better, and the more "exerting" the better for the body. When a massage makes a pig-like sound, the massage technician will immediately say, "This muscle is not good, let me give you a good massage." When you massage vigorously, the entire muscle and nerves are in a tense state, and the corresponding position will be sore the next day, which is actually a kind of injury.

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Improper massage or excessive stretching may even cause trauma to the blood vessels in the neck. The cervical and vertebral artery dissection caused by these traumas is a potential risk of stroke.

Because there are many blood vessels in the neck that lead to the brain, one of which is a very important artery, the internal carotid artery, which supplies most of the blood in the brain tissue. Improper massage may cause carotid artery dissection and thrombosis, which will break off and enter the brain with the blood, blocking the middle cerebral artery.

2. What exactly is this dangerous “carotid artery dissection”?

Cervical and vertebral artery dissection is a tear in the intima of the cervical artery, which causes blood to flow into the wall of the artery and form an intramural hematoma. Neck pain, headache, tinnitus, cranial nerve paralysis, such as hemiplegia, etc. are all symptoms of cervical artery dissection. Stroke is caused by intramural hematoma, which causes arterial stenosis, occlusion or aneurysm-like changes to form blood clots, leading to cerebral infarction.

One of the main causes of arterial dissection is trauma. The blood vessels in the neck are relatively fragile, and external forces can cause contusions of the inner, middle, and outer membranes. There are also abundant vasa vasorum under the outer and middle membranes of the carotid artery. The small vasa vasorum can easily rupture, forming an intramural hematoma or a dissecting aneurysm.

If a clear diagnosis is required, CTA, MRA or cerebral angiography can be used for further confirmation.

3. What are the common clinical manifestations of internal carotid artery dissection?

1. Many patients with internal carotid artery dissection experience symptoms of brain or retinal ischemia. The clinical symptoms are related to the location of the lesioned blood vessels and may manifest as limb weakness, slurred speech, blackouts/decreased vision, crooked mouth corners, diplopia, etc. In severe cases, it may cause coma.

Ischemic symptoms often appear minutes or weeks after neck pain, but usually do not exceed a month.

2. Local pain and cranial nerve involvement.

After the formation of cervical vascular dissection, local pain may occur in various forms, such as throbbing or stabbing pain, unilateral or bilateral. If secondary subarachnoid hemorrhage occurs, the headache will be severe.

In addition, some patients may experience pulsatile tinnitus, and a few patients with vertebral artery dissection may also experience unilateral upper limb pain. Patients may experience symptoms of cranial nerve palsy, with the hypoglossal nerve being the most common.

3. Triad of internal carotid artery dissection

These include Horner syndrome (miosis, ptosis, and mild enophthalmos without anhidrosis), neck pain, and neurologic deficits due to ipsilateral ischemia.

4. What are the triggering factors of carotid artery dissection?

The most common causes are trauma, excessive neck stretching, strenuous exercise, excessive yoga training, irregular neck massage, cupping, kissing the neck hard, severe coughing, and sneezing. They may all induce carotid artery dissection. Young people should be careful. After the onset of the disease, you need to see a doctor immediately and actively receive antithrombotic treatment to prevent further thrombosis. If the drug treatment is not effective, you must undergo surgery in time.