Roller coasters and cervical artery dissection

A 42-year-old woman with no vascular risk factors was admitted with neck pain and right Horner syndrome after riding a roller coaster. Magnetic resonance imaging (MRI) of her neck showed a characteristic crescent-shaped intramural haematoma in the right internal carotid artery1 (Figure, A), confirmed by magnetic resonance angiogram (MRA) (Figure, B). T1-fat-suppressed MRI and arterial wall imaging are currently the most sensitive techniques for diagnosis of dissection. Riding roller coasters has been associated with shearing neck injury leading to cervical artery dissection.2 Our patient was treated with warfarin for 6 months, leading to the intramural haematoma resolving and the Horner syndrome greatly improving.

Figure

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A. T1-fat-suppressed MRI of neck. Arrow: intramural haematoma in right internal carotid artery. B. MRA of neck. Arrow: narrowing of C1 segment of right internal carotid artery.