Stroke Following Blunt Head Trauma: A Case Report and Review of the Literature

Ischemic stroke due to blunt traumatic cerebrovascular injury (TCVI) is rare and often overlooked, particularly in patients without any typical predisposing factors. Approximately 1-2% of patients with blunt cerebrovascular trauma experience extracranial injuries, and around 10% of these patients develop strokes, resulting in an estimated 4,800 cases annually in the United States. These strokes can present with atypical symptoms, causing a delay in diagnosis. We report a case of a 36-year-old female who experienced headaches, left-sided weakness, and numbness following a football-related injury, and frequent use of a neck massager. Initially, her symptoms were attributed to a complex migraine; however, an MRI revealed a right thalamic infarct caused by the occlusion of the right posterior cerebral artery (PCA). Subsequent imaging showed further ischemic changes. As the patient's condition progressed, her management required a change to include heparin after initial treatments with aspirin and clopidogrel proved ineffective. This report highlights the challenges in diagnosing TCVI-induced stroke due to its uncommon presentation, atypical symptoms, and low clinical suspicion, especially in young adults. It underscores the importance of considering ischemic stroke in patients who have experienced neck trauma and raises awareness about the potential risks of unregulated neck massagers, which may cause vascular injury. Early cerebrovascular imaging, such as CT angiography (CTA), should be considered for trauma patients who present with neurological symptoms to facilitate timely diagnosis and treatment.