BMJ Case Reports 2013; doi:10.1136/bcr-2013-009840

Basilar artery thrombosis due to head banging: hazard of a religious ritual

  1. Rajasekharan Parvathy3
  1. 1Department of Internal Medicine, Medical College Hospital, Thiruvananthapuram, Kerala, India
  2. 2Department of Internal Medicine, Govt. Medical College Hospital, Thiruvananthapuram, Kerala, India
  3. 3Department of Internal Medicine, M.O.S.C. Medical College, Kolenchery, Thiruvananthapuram, Kerala, India
  1. Correspondence to Professor Chandrasekharan Rajasekharan, drcrajasekharan{at}


A 35-year-old woman, apparently normal, who had participated in traditional Devithullal (a religious dance form involving violent head banging for hours at a time) on the evening of the following day developed vomiting, urinary incontinence, altered sensorium and quadriplegia. All blood investigations including thrombophilia workup were normal. CT scanning of the brain was normal. MRI diffusion-weighted image showed the characteristic bilateral ventral pontine hyper intensities (figure 1A) and the apparent diffusion coeffient (ADC) map images showed bilateral ventral pontine hypointensities diagnostic of acute infarction (figure 1B). MR angiogram revealed basilar artery thrombosis (figure 2A,B).

Figure 1

(A) The diffusion-weighted image …

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article