With present day diagnostic imaging techniques, dissection of the cranial arteries is a diagnosis of suspicion in the scenario of major localised trauma to the neck in a patient who presents with neurological symptoms.
Advances in diagnostic imaging now allow the diagnosis of conditions that we would previously have been unaware of in general practice and emergency medicine. As a corollary, we now have to explore rare diagnostic possibilities in patients presenting with certain symptoms that in the past usually got better with conservative treatment.
Paraesthesia after swimming
A 19-year-old woman walked into the emergency department with paraesthesia of her right arm after a midday swim in a pool. She had been swimming freestyle, with no diving, and had not sustained a sudden injury. On leaving the water, she noticed her right little finger became numb. Subsequently the numbness encompassed the medial three fingers and progressed up the medial forearm. Right upper limb weakness developed, as did right lateral neck pain radiating into her shoulder and right side of her face.