Disclosures: Stephanie E. DeLuca, MS, MD: No financial relationships or conflicts of interest

Case Description: A 43-year-old left-handed, elite male cyclist with a history of migraines, presented to the emergency department with progressive headaches, acute left-sided weakness, slurred speech, vomiting, and diplopia. He denied any acute trauma. Imaging showed a right MCA infarct, right carotid artery dissection, and left carotid artery pseudoaneurysm. He received tPA and underwent a thrombectomy. In retrospect, he endorsed a history of repetitive high-speed cycling trauma with subsequent cervical fracture. Such trauma was postulated to be the etiology of his carotid disease. He was discharged to acute inpatient rehabilitation, where his visual deficit progressed and required further acute care. Eventually, a Cardiovascular Performance team initiated low to moderate-intensity aerobic exercise with the long-term goal of return to prior level of fitness.

Setting: Acute Inpatient Rehabilitation Facility

Patient: Previously healthy 43-year-old man Assessment/

Results: Initial exam was remarkable for dysarthria, mild attention deficits with impulsivity and poor insight, right visual field defect, and left upper extremity coordination deficits. Berg Balance Scale Short Form score was 22/28.

Discussion: There is a dearth of evidence-based guidelines regarding return to sport in elite athletes with cerebrovascular disease. Clinicians must consider the stroke etiology, the athlete’s deficits, and the potential impact on respective sport. Overall, cycling is a non-weightbearing, non-impact, and well-tolerated sport with the exception of its collision risk. While it is important to consider balance, strength, vision, and reaction time, safety in cycling depends on patient education, local cycling infrastructure, decision-making, bike-handling skill and coordination, and appropriate equipment setup. It is critical to manage these patients with an interdisciplinary approach, including clinicians with an understanding of the sport.

Conclusion: Return to sport guidelines in elite cyclists with spontaneous carotid artery dissections have not been well-established in the literature. It is critical to focus efforts on devising sport-specific guidelines in such patients who strongly identify with their respective sport.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/return-to-the-bike-after-a-spontaneous-carotid-artery-dissection-in-an-elite-cyclist-a-case-report/