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Mediastinal Emphysema After Head-Banging in a Rock Artist: Pseudo Shaken-Baby Syndrome in Adulthood

2012; Elsevier BV; Volume: 94; Issue: 6 Linguagem: Inglês

10.1016/j.athoracsur.2012.05.054

1552-6259

Saeko Matsuzaki, Koichi Tsunoda, Tonghyo Chong, Reo Hamaguchi,

Traumatic Ocular and Foreign Body Injuries

A 34-year-old man was seen because of severe right neck pain. He was a guitarist in a special type of heavy metal rock (so-called visual-kei, a subgenre related to glam-rock) band and habitually shook his head violently throughout concert performances. He regularly experienced neck and chest pain after a concert, which persisted for some time. Computed tomography scanning of the neck showed mediastinal emphysema. We surmise that head-banging resemble those of shaken-baby syndrome. A 34-year-old man was seen because of severe right neck pain. He was a guitarist in a special type of heavy metal rock (so-called visual-kei, a subgenre related to glam-rock) band and habitually shook his head violently throughout concert performances. He regularly experienced neck and chest pain after a concert, which persisted for some time. Computed tomography scanning of the neck showed mediastinal emphysema. We surmise that head-banging resemble those of shaken-baby syndrome. Head-banging, head-rolling, and body rocking are all common rhythmic habits in infants. These habits may cause carotid artery dissection [1Jackson M.A. Hughes R.C. Ward S.P. McInnes E.G. “Headbanging” and carotid dissection.Br Med J (Clin Res Ed). 1983; 287: 1262Crossref PubMed Scopus (42) Google Scholar], subdural hemorrhage [2Mackenzie J.M. “Headbanging” and fatal subdural haemorrhage.Lancet. 1991; 338: 1457-1458Abstract PubMed Scopus (23) Google Scholar], and neck injury [3Patton D. McIntosh A. Head and neck injury risks in heavy metal: head bangers stuck between rock and a hard bass.BMJ. 2008; 337: a2825Crossref PubMed Scopus (11) Google Scholar]. Similar injuries caused by head-banging are occasionally seen in adults who regularly play at or attend heavy metal rock concerts. We report a case in which head-banging in a musician ruptured an occult bulla, causing mediastinal emphysema. A 34-year-old man was seen because of severe right neck pain different from his usual recurrent tonsillitis episodes in that the pain was not localized to the throat, but also involved the neck. There was no fever. Upon taking a thorough history, we learned that the patient was a guitarist in a special type of heavy metal rock (so-called visual-kei, a subgenre related to glam-rock) band. He usually experienced neck and chest pain immediately after a concert, which persisted for some time. A pneumothorax was considered but no features of such were noted on a chest radiograph. A computed tomography of the neck demonstrated mediastinal emphysema. The patient was placed on antibiotics and analgesics and symptoms resolved in a week (Fig 1). The mediastinal air was no longer present on a subsequent computed tomographic scan. The patient is a famous musician, and DVDs of his concert performances are widely available. When reviewing recordings of his performances, we noted that he shook his head violently throughout the concerts, referred to in the rock music world as “head-banging.” Other members of the band and many of the audience also engaged in head-banging in time to the music during the entire live concerts. Mediastinal emphysema is a condition in which air collects in the interstices of the mediastinum. The three main causes [4Fauci A. Braunwald E. Kasper D. Harrison's Principles of Internal Medicine. 17th ed. McGraw-Hill, New York2008: 1661Google Scholar] are the following: (1) alveolar rupture with dissection of air into the mediastinum; (2) perforation or rupture of the esophagus, trachea, or main bronchi; and (3) dissection of air from the neck or the abdomen into the mediastinum. Jones and Kundrotas [5Jones R. Kundrotas L. “HOOAH!” A case of pneumomediastinum in the military training environment; Hamman's sign 71 years later.Mil Med. 2011; 176 (325–5)Google Scholar] reported a case of mediastinal emphysema that occurred after vigorously and repeatedly shouting “Hooah!” while attempting to outperform others in a military training environment. Recreational drugs are frequently taken by rock musicians, and cocaine use is associated with mediastinal emphysema. Cocaine use is, however, infrequent in Japan and our patient did not show any signs of drug abuse. Neck pain, which occurred immediately after an exhausting 2-hour performance, was the sole symptom in our patient,. We finally surmised that repeated head-banging had ruptured an occult bulla, leading to mediastinal emphysema. The results of voluntary head-banging in adulthood can resemble those seen in shaken-baby syndrome. To prevent injury due to such head-banging, the range of head and neck motion should be reduced, slower-tempo music should replace heavy metal rock, the frequency of head-banging should be only on every second beat, or personal protective equipment should be used [3Patton D. McIntosh A. Head and neck injury risks in heavy metal: head bangers stuck between rock and a hard bass.BMJ. 2008; 337: a2825Crossref PubMed Scopus (11) Google Scholar]. Unfortunately, it is difficult, if not impossible, to change the habits of heavy metal aficionados. This research was supported in part by a grant-in-aid from the National Hospital Organizationof Japan.