title: [Bilateral cerebellar infarction caused by intracranial dissection of the vertebral artery after long periods of "Shiatsu"].
abstract: For five years, a 56-year-old woman had undergone "Shiatsu" (a technique that uses fingers and the palm of the hand to apply pressure to particular sections of the body's surface to correct neck stiffness and body imbalances in order to maintain and promote health). She suddenly developed neck pain, dizziness, dysphagia, and speech and gait disturbances during treatment. A neurological examination detected bradylalia and truncal and mild bilateral limb ataxia of the cerebellar type. Diffusion-weighted brain MRI showed multiple hyperintense signal lesions at the bilateral cerebellar hemisphere in the posterior inferior cerebellar artery territory. Three-dimensional computed tomographic angiography (3D-CTA) revealed irregular stenosis of the intracranial right vertebral artery (string sign). Dissection of the intracranial portion of the vertebral artery owing to trauma is rare. Physicians need to be aware of patients who have acute dissecting infarction after long periods of repeated trivial pressure such as "Shiatsu". 3D-CTA is a very useful diagnostic procedure for arterial dissection.
authors.affiliation: Departmetnt of Neurology, Dokkyo Medical University, 880 Kitakobayashi Mibu, Shimotsuga-gun, Tochigi 321-0293, Japan.
authors.forename: Hisatake
authors.initials: H
authors.lastname: Iwanami
authors.forename: Masaaki
authors.initials: M
authors.lastname: Odaka
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D019050:Acupressure / Q000009:adverse effects*; D000208:Acute Disease; D000792:Angiography; D000925:Anticoagulants / Q000008:administration & dosage; D001120:Arginine / Q000031:analogs & derivatives; D002531:Cerebellum / Q000098:blood supply*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D010875:Pipecolic Acids / Q000008:administration & dosage; D013449:Sulfonamides; D014057:Tomography, X-Ray Computed; D020217:Vertebral Artery Dissection / Q000175:diagnosis / Q000209:etiology*; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D010875:Pipecolic Acids; D013449:Sulfonamides; D014859:Warfarin; D001120:Arginine; C031942:argatroban