Symptomatic bilateral extra-cranial vertebral artery dissections induced by sexual activity

Abstract

Introduction: Trauma is a well-recognized cause of vertebral artery dissection (VAD) and even minor episodes of trauma, including sneezing and vigorous exercise, have been implicated. Symptomatic bilateral vertebral artery dissections after sexual activity to our knowledge has not been reported.

Case report: A 32-year-old female presented with a three week history of occipito-cervical headaches. Noninvasive imaging identified bilateral vertebral artery dissections. The etiology was inferred after a directed clinical history revealed sexual activity characterized by aggressive repeated neck hyperextension from hair-pulling during intercourse.

Conclusion: We report a case of symptomatic bilateral VAD in the setting sexual intercourse related trauma. The quality of clinical data gathering, in particular pertinent history taking is imperative in determining a potential cause. This is important in patient counselling so as to prevent recurrence.