# Vertebral Artery Dissection and Lateral Medullary Syndrome Following a High-Intensity CrossFit Workout

## TL;DR

A 32-year-old woman suffered a stroke after a high-intensity CrossFit workout, highlighting the risk of vertebral artery dissection in young adults.

## Contribution

This case highlights the rare but important link between intense physical activity and vertebral artery dissection in young individuals.

## Key findings

- A high-intensity CrossFit workout led to vertebral artery dissection and lateral medullary syndrome in a previously healthy woman.
- Early recognition and treatment with antiplatelet therapy and rehabilitation led to full recovery.
- Severe or atypical headaches after strenuous activity should prompt consideration of vertebral artery dissection in young patients.

## Abstract

Cervical artery dissection (CAD), including carotid and vertebral artery dissection (VAD), is an uncommon but important cause of ischemic stroke in young adults. We report the case of a 32-year-old previously healthy woman who developed lateral medullary (Wallenberg) syndrome secondary to a right VAD following a high-intensity CrossFit session involving heavy lifting. She initially presented with right-sided headache and dizziness, which were misattributed to migraine, and over the following days developed dysphagia, right facial hypoesthesia, Horner’s syndrome, and contralateral sensory loss. Computed tomography angiography (CTA) confirmed right VAD, and brain magnetic resonance imaging (MRI) demonstrated a lateral medullary infarction. The patient was treated with dual antiplatelet therapy (DAPT) and underwent multidisciplinary neurorehabilitation, achieving complete functional recovery (modified Rankin Scale (mRS) score = 0). This case underscores the importance of considering VAD in young patients presenting with severe or atypical headaches after strenuous activity, even when initial neurological examination and imaging appear normal, as early recognition and treatment are crucial to prevent disabling stroke outcomes.