Disclosures: Nadja N. Mencin, MD: Nothing to disclose

Case Description: The patient is a 44-year-old woman with history of asthma and migraines. On the day prior to presentation she had a typical migraine attack and attempted to relieve the pain with a compact shiatsu neck massager, a technique which had given her relief in the past. The shiatsu massager was draped around her neck with the 2 massing plates located laterally. As her headache lateralized to the right side of her head, she applied pressure to the right massage plate with her hand and held it there for several minutes, on and off for approximately 1 hour. After putting the massager down and standing she developed L arm plegia and numbness. When patient arrived in the ED a stroke code was called.

Setting: Tertiary Care Hospital

Patient: 44-year-old woman with history of migraines and asthma who presented with left arm numbness and weakness.

Assessment/Results: An MRI of the brain showed multiple small acute infarctions of the right MCA and ACA suggestive of emboli. CT angiogram showed right ICA dissection at the carotid bifurcation and changes suggestive of FMD in the left ICA.

Discussion: Massage and massagers are often used on patients in inpatient and outpatient rehabilitation as a way to relieve pain as an alternative or in conjunction with pain medication. This case demonstrates how improper and prolonged use of a compact massager can lead to ICA dissection and stroke.

Conclusion: Use of a compact neck massager in the cervical area can lead to stroke secondary to ICA dissection, which can cause vessel stenosis or embolization of clot from the false lumen. Patients with pre-existing conditions such as FMD may be especially susceptible to TIA/stroke when using a compact neck massager.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/stroke-secondary-to-right-ica-dissection-caused-by-use-of-a-compact-shiatsu-neck-massager-in-the-setting-of-fibromuscular-dysplasia-fmd/