Life-threatening neurovascular injuries associated with recreational use of "banana" boats

Banana boat rides are a popular form of recreation worldwide. Recommendations that speed should not exceed 15 mph, passengers should wear protective gear, and an observer should be present on the towing boat are generally ignored. Medical personnel at tourist venues and general practitioners may not be attuned to the risk of serious injury. We present our experience in the management carotid- and vertebral artery dissections sustained by 44- and 23-year-old males during banana boat rides. In both cases, the dissections were misdiagnosed until patients presented to the Emergency Department two days after injury. In the first patient, medical management failed and endovascular treatment was required due to neurological deterioration. In patient two, anticoagulation therapy prevented embolic sequelae. Boat operators, passengers, and the medical personnel who are first to see these patients should be aware of the risk of arterial dissection to facilitate early detection of these potentially life-threatening injuries.