bjjdissection.org

Injury types

Two arteries, two very different injuries.

An artery wall has layers, like a hose made of laminated sheets. A dissection is a tear in the inner lining that lets blood push in between the layers. Where that happens — the carotid at the front of the neck, or the vertebral threaded through the neck bones — changes everything about how it happens and how it feels.

Carotid (ICA) ↓
Vertebral (VA) ↓

  • 01 · Carotid — ICA

    Internal carotid artery dissection & pseudoaneurysm

    The internal carotid artery runs up the front-side of your neck, just under where a collar sits — right where a well-placed collar choke sits too.

    What actually tears

    A tear in the inner lining creates a second channel — a false lumen, where blood was never meant to flow. That false channel causes trouble two ways: it can bulge inward and narrow the real channel, reducing blood flow to the brain, and the raw, injured surface can form clots that break off and travel upstream into the brain — a stroke.

    Where a pseudoaneurysm comes in

    Sometimes the outer wall balloons outward at the injury site, forming a pseudoaneurysm — a bulge contained by the outer layers rather than a full, normal artery wall. Many are followed with repeat imaging rather than treated aggressively, but management varies with size, symptoms, and location.

    How it’s usually found

    Diagnosis generally involves imaging of the neck vessels — commonly CT angiography or MR angiography. The delay between injury and diagnosis is one of the things this site’s registry tracks, because “it was dismissed as a muscle strain” is a recurring theme in survivor accounts.

    How grappling loads this artery

    The internal carotid is relatively fixed where it enters the skull base and relatively mobile in the neck — so forces that combine compression with rotation or extension concentrate stress at those transition points. In practical grappling terms, positions that stack compression, rotation, and time include:

    • Collar chokesCross collar, bow and arrow, loop choke: direct, sustained pressure over the artery’s path.
    • Guillotines and arm-in variationsCompression plus neck flexion and often a twist.
    • Kesa gatame and head-and-arm pressureSustained lateral load on the side of the neck.
    • Stack passes and can openersExtreme flexion, sometimes with rotation, under an opponent’s weight.

    Naming these positions is not saying they are unsafe or should be banned. Millions of rolls happen without injury. It is saying that if a dissection occurs, this is the kind of loading that shows up in the story.

  • 02 · Vertebral — VA

    Vertebral artery dissection, segment by segment

    The vertebral arteries run up the back of your neck, threaded through small openings in the neck bones themselves. That bony path is what makes them vulnerable in a completely different way than the carotids — and why the symptoms can look nothing like what people expect from a “stroke.”

    The four segments, and why they matter

    V1

    From where it branches off, up to where it enters the bony canal. Relatively mobile.

    V2

    Inside the bony canal through the neck vertebrae. Fixed in bone, so the artery is dragged along with whatever the neck bones do.

    V3

    The stretch between the top vertebra and the skull, where the artery loops and turns sharply. Frequently implicated in rotation-related injuries.

    V4

    Inside the skull, after piercing the covering of the brain. Dissections here carry different considerations than the neck segments.

    Why the symptoms look different

    The vertebral arteries feed the back of the brain — the brainstem and cerebellum, which handle balance, coordination, eye movement, and swallowing. So a vertebral dissection may announce itself as sudden vertigo, clumsiness on one side, double vision, trouble swallowing, or a severe pain at the back of the head and neck, rather than the classic face-droop-and-arm-weakness picture people associate with stroke.

    This is exactly why these injuries get missed: a dizzy, nauseated grappler with a stiff neck reads as dehydration or a bad shot to the head, not as an arterial emergency.

    How grappling loads these arteries

    Because V2 is locked inside bone and V3 loops around the top of the spine, rotation is the dominant theme. Forces that rotate the head at end range — especially combined with extension or traction — put the most stress on those fixed and looping stretches:

    • Neck cranks and twisting escapes — rotation at end range under force.
    • Stack passing — the neck folded and often twisted under a partner’s full weight.
    • Inversions and ashi garami scrambles — the head bearing load in unusual orientations.
    • Takedowns landing on the head or shoulder — sudden rotation and impact together.

    As with the carotid, this is a description of loading patterns that appear in survivor accounts — not a risk ranking, and not a claim about how likely any position is to cause harm.

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