title: Internal carotid artery dissection after a roller coaster ride in a 4-year-old: case report and review of the literature.
abstract: BACKGROUND
  Strokes associated with roller-coaster rides are unusual.
  
  
  METHODS
  A previously healthy 4-year-old boy developed acute onset of left-sided weakness when flying home from a trip to an amusement park. He had frequented two roller coaster rides the day prior. Upon evaluation, he was found to have an acute right middle cerebral artery territory infarction.
  
  
  RESULTS
  Cerebral angiography showed dissection of the right cervical internal carotid artery and right middle cerebral artery occlusion involving the M1 segment. He was treated with aspirin. Evaluation for underlying connective tissue diseases was unremarkable.
  
  
  CONCLUSIONS
  We speculate that repetitive forces of acceleration and deceleration may have led to a cervical internal carotid artery intimal tear, followed by thromboembolism. It remains uncertain what the threshold of susceptibility to repetitive rotational changes and tolerability to G forces in an otherwise healthy child truly is.
authors.affiliation: Department of Neurology, University of Connecticut, Hartford Hospital, Hartford, Connecticut.
authors.forename: Amre
authors.initials: A
authors.lastname: Nouh
authors.affiliation: Department of Neurology, Loyola University Chicago Stritch School of Medicine, Loyola University, Maywood, Illinois.
authors.forename: Daniel
authors.initials: D
authors.lastname: Vela-Duarte
authors.affiliation: Department of Neuroradiology, Advocate Christ Medical Center, Oak Lawn, Illinois.
authors.forename: Thomas
authors.initials: T
authors.lastname: Grobelny
authors.affiliation: Loyola University Chicago Stritch School of Medicine, Loyola University, Maywood, Illinois.
authors.forename: George
authors.initials: G
authors.lastname: Hoganson
authors.affiliation: Department of Radiology, Loyola University Chicago Stritch School of Medicine, Loyola University, Maywood, Illinois.
authors.forename: David
authors.initials: D
authors.lastname: Pasquale
authors.affiliation: Department of Neurology, Loyola University Chicago Stritch School of Medicine, Loyola University, Maywood, Illinois. Electronic address: jbiller@lumc.edu.
authors.forename: José
authors.initials: J
authors.lastname: Biller
mesh_terms: D001265:Athletic Injuries / Q000150:complications*; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000209:etiology*; D002533:Cerebral Angiography; D002675:Child, Preschool; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D008297:Male
keywords: amusement park; cervical carotid artery dissection; pediatric strokes; roller coaster