Carotid artery dissection linked to intermittent apnoeic swimming: A case-control study.
Damian M Bailey, Richard G Davies, Brenig L Gwilym et al.
✦ AI-curated · Sources linked
Case in brief
A hypertensive, 50-year-old male triathlete developed left-eye blurred vision, ipsilateral headache and pulsatile tinnitus after intermittent apnoeic (“pyramid breathing”) swimming, followed by left ptosis and miosis consistent with Horner’s syndrome. Neuroimaging showed a left internal carotid artery dissection and an incidental distal right internal carotid artery pseudoaneurysm. He recovered with pharmacological and dietary management of hypertension and a graduated return to activity; imaging showed significant re-expansion of the left artery’s true lumen. A dry-land simulation in a matched healthy control found greater exercise-induced carotid shear stress with dynamic apnoeic than normal breathing.
What made this case unusual
The dissection followed intermittent apnoeic swimming, and a laboratory simulation suggested that dynamic apnoeic breathing produced greater carotid shear stress than normal breathing. The authors proposed this, in the setting of hypertension, as a possible precipitating factor—not a proven cause.
Diagnostic / clinical pearl
In a patient with headache, visual symptoms and ipsilateral Horner’s syndrome, consider internal carotid artery dissection and confirm with neuroimaging; ask about recent exertion, including apnoeic swimming.