PhotoTwo roller coaster rides on a family vacation are being blamed for a stroke in a four-year-old boy. The case was reported by doctors at Loyola University Medical Center in Chicago, where the boy was treated.

Prior to his stroke, the boy was healthy. But during an out-of-state vacation with his parents, he rode two roller coasters. The next day while on the flight back home, the boy vomited and developed a droop on the left side of his face. By the time he arrived home, he was unable to walk and had weakness on his left side.

He was rushed to the hospital, where imaging exams showed he had experienced a carotid artery dissection and stroke. He received low-dose aspirin and doctors observed a steady improvement. At a six-month follow-up visit, his gait had improved considerably, and he had only mild muscle weakness and stiffness on the left side.

Sudden movements

Sudden movements that can hyperextend the neck or rotate the neck -- such as whiplash, certain sports movements or even violent coughing -- can result in a dissection of the carotid artery. A dissection begins as a tear in one layer of the artery wall. A blood clot can form in the area of the tear. If it's large enough, the clot can block blood flow to the brain. Or, pieces of the clot can break free, travel up to the brain and block blood flow to the brain. In either case, the result is a stroke.

A child under age 10 is vulnerable to sudden neck movements and rotations due to weak neck muscles, a relatively large head and other factors. "This hypermobility, combined with other kinetic and linear forces experienced during a roller coaster ride, could theoretically explain why some children, albeit rarely, sustain dissections," Dr. Jose Biller and colleagues wrote in a scholarly article on the subject. 

Strokes previously have been reported in adult roller coaster riders, but there are only a few previous reports of strokes in children who rode roller coasters, including a 13-year-old girl and an 11-year-old boy. The 4-year-old boy described by Loyola neurologists is one of the youngest reported in the medical literature.

Biller is an internationally known expert on strokes in children and young adults. He has written a textbook on the topic and is a co-author of the American Heart Association's guidelines for management of stroke in infants and children. 

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