Dissection of the Common Carotid Artery in a Jujutsu Practitioner: A Case Study

PREVENTION STRATEGIES IN COMBAT SPORTS


Jujutsu includes strangulation techniques and has been shown to be relatively safe when practiced under proper supervision.


Coaches or instructors of any sport—especially martial arts—must hold a first aid certification issued by an accredited organization. It is common to find instructors without proper first aid training teaching resuscitation techniques based on non-scientific approaches, which can be dangerous. Often, these methods are not validated by modern medicine and may worsen the injured person's condition instead of helping.


However, to minimize the risk of cerebrovascular events associated with strangulation techniques, the following recommendations are proposed:


Use of Safe and Controlled Techniques


  • Proper instruction on the biomechanics of chokes.
  • Avoiding prolonged or excessive pressure on the neck.
  • Teaching submission signals and recognizing signs of hypoxia.

Recovery Time After Intense Strangulation

  • Avoid immediate return to activity following a loss of consciousness.
  • Seek medical evaluation if neurological symptoms occur after practice.


Medical Evaluation and Early Detection


  • Athletes with a history of migraines, vertigo, or transient neurological symptoms should be evaluated by a specialist before participating in combat.
  • In suspected cases of arterial dissection, early diagnosis through imaging can prevent serious complications.

Conclusion

The case described below illustrates an uncommon but potentially serious complication of combat sports. Carotid artery dissection should be considered in patients with a history of neck trauma, especially if they present with delayed-onset neurological symptoms. Optimal management includes early imaging diagnosis, endovascular therapy when needed, and antiplatelet treatment to prevent recurrence. Although prognosis is generally favorable, a preventive approach is strongly recommended in sports involving chokes to reduce the risk of cerebrovascular events.


Below is a summary of a case study involving carotid artery dissection caused by a Jujutsu practitioner during the application of a strangulation technique known as the Ezekiel choke, or Sode Guruma Jime.


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Introduction and Case Presentation

We present a case of internal carotid artery dissection in a young man with no relevant medical history. The patient, a Jujutsu practitioner, experienced a cerebrovascular event following a training session that involved the application of a chokehold. Although initially asymptomatic, he developed a headache and neurological symptoms several hours later, prompting an emergency department evaluation.


Mechanism of Injury and Diagnosis

The arterial dissection was caused by pressure applied to the neck during the choke, resulting in a tear in the wall of the internal carotid artery. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the presence of an intramural hematoma.


Treatment and Management

The patient was treated with anticoagulation and endovascular management to prevent further complications. Early intervention led to a favorable recovery, with no significant neurological sequelae. Follow-up imaging demonstrated satisfactory resolution of the hematoma.


Risk Factors and Prevention

Although such injuries are rare, factors such as hypertension, smoking, and certain vascular malformations increase the risk. In combat sports like Jujutsu, a preventive approach is recommended. This should include controlled techniques, proper instruction in chokeholds, and regular medical evaluations to detect potential vascular injury risks.


Conclusion

This case highlights the importance of early assessment in patients with post-traumatic neurological symptoms and underscores the need for caution in teaching choke techniques in Jujutsu and other martial arts.


References and Resources:




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