39 Whiplash injury – a medicolegal issue

Abstract

Introduction: Mirror illusion consist in the fact that, standing in front of a mirror put in a sagittal plane, with our head on one side and one arm stretched forward, we can see one side of our body reflected as if it were the other side, by mirror visual feedback. The aim of this study was to monitor blood flow changes in medial cerebral artery (MCA) by means of Transcranial Doppler (TCD) in individuals during motor tasks as well as tasks using mirror visual feedback. Subjects and methods: Eight young healthy volunteers (four male and four female) participated in this study. TCD recording of MCA was done during each task consisting of various motor and visuo-motor activities using mirror illusion. Both MCA mean blow flow velocity (MBFV) were measured while individuals seated in a comfortable chair. The obtained MCA MBFV are presented as baseline values Results: During the illusion of motoric hand activation, when the subject is making right hand flexions and watching its reflexion in the mirror, while the left hand is immobile, increase of mean blood flow velocity of contralateral MCA was observed (task 3 + 4.5% than in baseline values, P = 0.017). Furthermore, when the subject made left hand flexions while watching the reflection of the immobile right hand in the mirror, there was increase of MBFV in right MCA (+5.6% than in baseline values P = 0.044), more pronounced than during the illusion of motoric hand activation (task3) and less than during direct vision of hand flexion (task 2 + 6.3%than in baseline values P = 0.005). Conclusion: Our data showed that visual illusion of action, as well as direct action observation can increase mean blood flow value in MCA, which brings forward the possible usage of mirror illusion as a tool for motoric neurorehabilitation. Once considered rare, dissection of the internal carotid artery or vertebral artery is an increasingly recognized entity. Craniocervical arterial dissection is an uncommon cause of stroke in the general population, but is relatively common in patients below the age of 40. The early clinical manifestations are often subtle, however, permanent neurologic disability and death can result if the diagnosis is delayed. The present report describes eight patients (four men and four women) with dissection of the craniocervical arteries. Patient history was taken and clinical neurologic examinations were performed immediately upon admission. Diagnostic procedures included ultrasound (CDFI and TCD) and radiologic (computed tomography and digital subtraction angiography) examinations. The leading symptoms were focal neurologic deficits, and headache and neck ache. Ultrasound findings (CDFI) were positive for vessel dissection in seven (87.5%) patients, and DSA was consistent with dissection in five (62.5%) patients and negative in one patient, whereas in two patients this examination was not performed due to the known allergy to contrast medium. Five (62.5%) patients were treated with anticoagulants, one with platelet aggregation suppressants, and two patients w...

Relationship between neck motion and self-reported pain in patients with whiplash associated disorders during the acute phase

“…Objective physical measures are also valuable assessment instruments, specially in medico-legal frameworks that require objective evidence of injury or significant consequences for the claimant's life (Bošnjak-Pašić et al, 2007;Oliphant, 2016;Pujol Robinat, 2017). They can be useful to objectify persistent pathology (Elliott et al, 2013), or as complementary measures to quantify specific motor control and function deficits (Misailidou et al, 2010).…”