Vertebral artery dissection in weightlifter with performance enhancing drug use

Area of Science:

• Neurology
• Sports Medicine
• Toxicology

Background:

• Vertebral artery dissection (VAD) is a significant cause of stroke in young adults.
• Weight training, particularly with heavy loads across the neck and shoulders, can pose risks.
• Performance-enhancing agents (PEAs) are increasingly used by athletes, with known associations to cardiovascular events.

Observation:

• A young male bodybuilder presented with symptoms of transient ischemic attack (TIA).
• The TIA was diagnosed as secondary to vertebral artery dissection (VAD).
• The event occurred after a session of intense weight training involving heavy weights across the back and shoulders.

Findings:

• The patient reported concurrent use of multiple performance-enhancing agents, including anabolic steroids, slimming agents, stimulants, and human growth hormone.
• While VAD has been linked to cervical manipulation and anabolic steroids to embolic strokes, this is the first reported case associating VAD with both weight training and anabolic steroid use.
• This case suggests a potential multifactorial etiology involving biomechanical stress from weightlifting and pharmacological effects of PEAs.

Implications:

• Highlights the potential risk of VAD in young athletes engaging in heavy weight training, especially when combined with PEA use.
• Suggests the need for increased awareness among healthcare providers regarding VAD risks in bodybuilders and athletes using performance enhancers.
• Underscores the importance of comprehensive patient history, including substance use, when evaluating neurological events in athletes.