An Attempt of Early Detection of Poor Outcome after Whiplash

Abstract

The main concern with whiplash is that a large proportion of whiplash patients experience disabling symptoms or whiplash-associated disorders (WAD) for months if not years following the accident. Therefore, identifying early prognostic factors of WAD development is important as WAD have widespread clinical and economic consequences. In order to tackle that question, our study was specifically aimed at combining several methods of investigation in the same WAD patients at the acute stage and 6 months later. Our longitudinal, open, prospective, multi-center study included 38 whiplash patients, and 13 healthy volunteers matched for age, gender, and socio-economic status with the whiplash group. Whiplash patients were evaluated 15-21 days after road accident, and 6 months later. At each appointment, patients underwent a neuropsychological evaluation, a full clinical neurological examination, neurophysiological and postural tests, oto-neurological tests, cervical spine cord magnetic resonance imaging (MRI) with tractography (DTI). At 6 months, whiplash patients were categorized into two subgroups based on the results of the Diagnostic and Statistical Manual of Mental Disorders as having either favorable or unfavorable progression [an unfavorable classification corresponding to the presence of post-concussion symptom (PCS)] and we searched retrospectively for early prognostic factors of WAD predicting the passage to chronicity. We found that patients displaying high level of catastrophizing at the acute stage and/or post-traumatic stress disorder associated with either abnormalities in head or trunk kinematics, abnormal test of the otolithic function and at the Equitest or a combination of these syndromes, turned to

Advanced magnetic resonance imaging of chronic whiplash patients: a clinical practice-based feasibility study

“…shorter scan time and higher risk of motion artifacts in the clinical study. Similar to our findings, a recent DTI study investigated the cervical spinal cord in 38 whiplash patients WAD grade I, II or III [ 16 ], demonstrating no significant differences between acute and chronic whiplash patients or at any group level on the DTI parameters (e.g. axial diffusivity and radial diffusivity).…”

“…Similarly, pathophysiological findings have been observed, e.g. lowered pain pressure threshold, altered balance and visual control, and hypersensitivity of the central nervous system [ 16 – 20 ]. Psychological studies have correlated anxiety, catastrophizing, post-traumatic stress disorder symptoms and pre-impact health to the prognosis following whiplash injury [ 21 , 22 ].…”

“…Hence, this method may be valuable in evaluating patients suffering from symptoms related to the cervical spine nerve roots and/or spinal cord. With the exception of one recent study [ 16 ], the cervical spinal cord or nerve roots in whiplash-injured patients have not been examined using DWI. In addition, the movement and function of the cerebrospinal fluid (CSF) that surrounds the cervical spinal cord may play a role in the clinical course of chronicity.…”

Incidence and characteristics of physical disabilities in patients with postconcussion syndromefollowing mTBI

“…[ 24 , 25 ] Furthermore, a few studies have reported that whiplash was associated with poorer outcomes or more severe traumatic axonal injury than other causes of head trauma. [ 28 ] Thus, the result showing that 7 out of 10 patients were associated with whiplash suggests that this may be a factor leading to the physical disability of patients with PCS after mTBI.…”

Evaluation of a Passive Model to Mimic Dynamic Head/Neck Movements

“…Whiplash has been defined as a fast motion of the head and neck without a direct force exerted onto the head. A major cause of neck injuries is car accidents, leading to whiplash associated disorders (Laporte et al 2016).…”