A woman's beach vacation took an unexpected turn when she was hit so hard in the neck by a wave that it ruptured one of her arteries, according to a recent report of her case.
The 60-year-old woman, who lives in Ireland, was vacationing at the beach when an ocean wave struck her in the neck.
Soon, she began to experience intermittent headaches and neck pain, according to the report, published Sept. 12 in the journal BMJ Case Reports. After two weeks, she was still having these symptoms, and one of her eyelids began to droop, prompting her to seek medical care. When doctors examined the woman, they noticed that one of her pupils was smaller than the other. [27 Oddest Medical Cases]
The woman was initially diagnosed with Horner syndrome, which refers to a combination of symptoms caused by a disruption in a nerve pathway from the brain to the face, according to the Mayo Clinic.
Many things can cause Horner syndrome. In the woman's case, further imaging tests revealed that she had "carotid artery dissection" (CAD) in her right carotid artery. This occurs when blood leaks into a tear within the wall of the carotid artery, and as the blood pools, it separates the layers of the blood vessel wall. The right carotid artery is one of four arteries in the neck that delivers blood to the brain.
The dissection likely happened because the wave's impact led to a rupture of the "vasa vasorum," or the small blood vessels within the wall of the carotid artery, the authors wrote in the report.
Dr. Etimbuk Umana, an emergency medicine doctor at Galway University Hospitals in Ireland, who treated the patient, said that, prior to the woman's case, he had never seen or read any reports of a beach wave causing CAD. But unusual neck movements or blunt trauma to the neck (such as trauma experienced in a car crash) are known causes of CAD, he told Live Science. It's estimated that trauma causes up to 40 percent of cases of CAD, the authors wrote.
One concern for patients with CAD is the risk of stroke; indeed, the condition is a common cause of stroke for people under 50, according to the Cedars-Sinai medical centerin Los Angeles. A stroke can occur if a blood clot forms at the site of the blood vessel dissection and that clot blocks the flow of blood to the brain.
For this reason, patients with CAD may be treated with anti-clotting drugs (such as blood thinners) to prevent stroke.
But for patients who have a rupture of the vasa vasorum, anti-clotting drugs might actually pose a risk of increased bleeding, the report said.
The woman was initially treated with anti-clotting drugs, but the treatment was stopped, in part due to concerns about bleeding risk. Also, the woman didn't have any signs of stroke or other brain problems.
The woman was monitored closely and took Lyrica (pregabalin), a medicine used to treat nerve pain, to help with her pain. Six months later, tests showed that the artery injury had completely healed. The authors said that more studies are needed to weigh the risks and benefits of anti-clotting drugs for patients like the one in this report.
Originally published on Live Science.
