Vertebral Artery Dissection Induced by Fitness Video Game Exercise: A Case Report

BACKGROUND Vertebral artery dissection (VAD) is an important cause of ischemic stroke in young adults and is often associated with mechanical stressors such as trauma, sudden neck movements, or intense physical activity. While video games are not traditionally recognized as a risk factor, the increasing popularity of interactive fitness games calls for attention to their potential health implications. CASE REPORT We present the case of a 25-year-old sedentary woman with no vascular risk factors who developed acute left-sided neck pain while performing repetitive overhead pushing and pulling movements using a resistance-based controller during gameplay with Ring Fit Adventure (Nintendo Co., Ltd.), a home fitness video game. Two days later, she experienced sudden-onset left-sided numbness and visual disturbance. Neurological examination revealed left homonymous hemianopia and hemisensory deficits. Brain MRI revealed an acute infarct in the right occipital lobe, and magnetic resonance angiography showed right posterior cerebral artery occlusion and dissection of the left vertebral artery with intramural thrombus. She underwent successful endovascular thrombectomy and intra-arterial thrombolysis, followed by dual antiplatelet therapy. Her symptoms improved markedly, and she was discharged with only mild visual field defect. Imaging at follow-up demonstrated vascular remodeling. No underlying vasculopathy or prothrombotic condition was identified. CONCLUSIONS This case highlights that even a seemingly benign fitness video game may exert sufficient mechanical stress to trigger VAD, particularly in untrained individuals. While the temporal association suggests a potential link, causality cannot be definitively established. As home fitness gaming becomes increasingly popular, it is important for both clinicians and the general public to be aware of rare but serious vascular complications that may arise from sudden, strenuous activity in previously sedentary individuals.