Abstract
Background
Strangulation as a fight-finishing maneuver in combat sports, termed “choking” in
that context, occurs worldwide millions of times yearly. This activity can be trained
safely, but devastating injuries can occur.
Objective
Our aim was to present a case series of cervical artery dissections and ischemic strokes
associated with sportive choking. Sharing these cases is meant to draw awareness,
to assist emergency physicians in caring for these athletes, and to provide a platform
for further research.
Methods
Institutional Review Board approval was obtained. Participants consented for medical
information transfer and anonymous academic reproduction. The minimum medical record
information necessary for inclusion was a report of diagnosis-confirming advanced
imaging. Participants were contacted for primary information in addition to what the
medical records could provide and to confirm some information in the record (e.g.,
pertinent medical history, demographic characteristics, choking event description,
medical care, and commentary on their current health). Medical records and additional
first-hand information were reviewed and participants were included if they had a
diagnosed dissection or stroke likely associated with a sportive choke.
Results
Ten cases met all criteria for inclusion. There were 5 cases of carotid artery dissection,
3 cases of vertebral artery dissection, and 2 cases of ischemic stroke without dissection.
Nine of 10 participants survived and 3 of 10 have returned to submission grappling
training.
Conclusions
Cervical artery dissections and ischemic strokes can occur in association with sportive
choking. Emergency physicians must be aware of the widespread nature of this activity
and must be vigilant in approaching management of patients with symptoms consistent
with these injuries.
Keywords
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Article info
Publication history
Published online: April 30, 2022
Accepted:
April 25,
2022
Received in revised form:
January 3,
2022
Received:
August 24,
2021
Identification
Copyright
© 2022 Published by Elsevier Inc.
