Игровая приставка и диссекция ВСА. (из журнала)

[Mikhail]

В последнем журнале Neurology интересная статья с картинками
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INTERNAL CAROTID ARTERY DISSECTION OCCURRING DURING INTENSIVE PRACTICE WITH WII® VIDEO SPORTS GAMES

In the last 6 months, 2 patients have been admitted to our stroke center for ischemic stroke related to internal carotid artery (ICA) dissection that occurred during intensive video sports game practice with Wii® gaming system, the new generation of interactive wireless gaming console. Wii® has been widely distributed only since December 2006 and an increasing number of associated-injury cases have been reported in the literature since June 2007 (severe osteoarticular injuries involving shoulder or knee and hemothorax).1–4 These cases illustrate the intensity of some efforts performed during the practice of these video sports games.

Case presentation. Our first case is a previously healthy 47-year-old woman who developed stroke due to ICA and middle cerebral artery (MCA) occlusion related to proximal ICA dissection during intense sports video game practice with the Wii® console system. She played a tennis video game for 3 hours consecutively, during which she experienced sudden severe left neck pain and unusual headache followed a few minutes later by right acute hemiplegia and aphasia (NIH Stroke Scale score = 15). In spite of partial MCA recanalization after intravenous thrombolysis (IVT), the patient was still dependent (modified Rankin score = 3) after 3 months.

The second case is a previously healthy 14-year-old boy (weight = 80 kg; height = 190 cm) who developed acute right orbital pain and sudden left global hemiplegia immediately after 2 consecutive 3-hour sessions of intensive running on the spot on the interactive wireless balance board accessory of the Wii® console system. Intracranial magnetic resonance angiography disclosed a right distal MCA occlusion related to intrapetrous ICA dissection. Full MCA recanalization was obtained after IVT but a left hemiparesis (modified Rankin score = 2) persisted at 3 months.

These patients had no cranial nerve palsy but patient 2 had a slight right Horner syndrome for a few days after stroke onset.

ICA dissection was diagnosed by MRI and CT angioscan in the 2 cases (figure) and IVT was performed before 3 hours after stroke onset and then relayed 24 hours later by anticoagulation. There was no sign of multiple dissections on several CT angioscans performed during hospitalization and after 1 and 3 months.

For each patient, a complete screening of well-known factors associated with cervical artery dissection was done. They had no migraine, hyperhomocysteinemia, or visible stigmata of defined connective tissue disorders. Furthermore, in the 2 cases, CT angioscan and intracranial and cervical magnetic resonance angiography demonstrated no sign of tortuosity, kinking or coiling, or fibromuscular dysplasia.

Discussion. In these 2 cases, the relationship between the video game practice and the occurrence of dissection is likely: minor trauma during sport practice is a well-known precipitating factor for ICA dissection, no clear cause of dissection was been found, and both patients presented an unilateral acute heralding headache before stroke during the video sports game session.

Furthermore, to obtain the highest virtual ball speed during tennis video gaming, some users tend to reproduce arm movements performed during the real sport practice but with larger amplitude (like our first patient) because of the lack of arm braking induced by the shock of a real racket against a real ball. The resulting higher torsion level of the cervicothoracic axis might increase the risk of cervical carotid dissection. In the same way, the virtual foot race requires an unusual extended running on the spot, source of repeated and high-frequency vertical shock waves able to induce shear force injury at the junction of extracranial and intrapetrous segments of ICA. The fact that our second patient performed an intensive running on the spot for 6 hours might explain the arterial wall injury through repetitive ICA microtrauma and the beginning of the dissection at the entry of the ICA in the petrous bone.5

Thus, in these 2 cases, very intensive video sports practice with interactive gaming system may have played a precipitating role in ICA dissection occurrence and then induced a significant disability.

In such context, the sudden occurrence of some symptoms frequently observed at the onset of carotid dissection, like an unusual and persisting unilateral headache or cervicalgia, in users of video sports game with general interactive gaming systems must alert physicians to look for other associated suggestive symptoms like ipsilateral ptosis and myosis, assess the status of cervical arteries, and give appropriate therapy to prevent stroke if ICA dissection is diagnosed.


1 Bonis J. Acute Wiiitis. N Engl J Med 2007;356:2431–2432.[Free Full Text]

2 Cowley AD, Minnaar G. New generation computer games: watch out for Wii shoulder. BMJ 2008;336:110.[Free Full Text]

3 Robinson RJ, Barron DA, Grainger AJ, Venkatesh R. Wii knee. Emerg Radiol 2008;15:255–257.[Medline]

4 Peek AC, Ibrahim T, Abunasra H, Waller D, Natarajan R. White-out from a Wii: traumatic haemothorax sustained playing Nintendo Wii. Ann R Coll Surg Engl 2008;90:W9–W10.[Medline]

5 Duncan MA, Dowd N, Rawluk D, Cunningham AJ. Traumatic bilateral internal carotid artery dissection following airbag deployment in a patient with fibromuscular dysplasia. Br J Anaesth 2000;85:476–478.[Abstract/Free Full Text]

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