Epidural Blood Patch Therapy for Chronic Whiplash-Associated Disorder

Abstract

We conclude that CSF leak should be considered in some cases of chronic WAD and that EBP is an effective therapy for chronic WAD.

A case-control study of cerebellar tonsillar ectopia (Chiari) and head/neck trauma (whiplash)

“…Thus, CTE has been found to be associated with both a history of whiplash trauma and FMS. Although there are more questions than answers generated by this observation, an appealing hypothesis is one that links FMS to whiplash injury via an acquired CTE resulting from the whiplash trauma, possibly secondary to the type of dural leak described by Ishikawa et al [17].…”

“…There is clinical evidence that dural leaks are associated with whiplash trauma and chronic symptoms; using radioisotope cisternography, Ishikawa et al [17] described the identification of CSF leaks, primarily in the lumbar spine at the dural sleeves, in 37 of 66 (56%) chronic whiplash patients with headache, memory loss, dizziness and neck pain, inter alia. The authors described substantial improvement in chronic symptoms in 32 of the 36 (88%) patients who agreed to epidural blood patch (EBP) therapy.…”

Spinal Cerebrospinal Fluid Leakage After Motor Vehicle Accident -Two Case Reports-

“…11) However, most spinal CSF leaks in motor vehicle accident patients are located in the lumbosacral spine. 6,8,13) This distribution is quite different from those found in SIH. This discrepancy is probably the main cause of the deep-seated mistrust of the diagnosis of spinal leaks based on radioisotope cisternography after motor vehicle accidents.…”

“…1,12) Several cases of such cerebrospinal fluid (CSF) leaks in motor vehicle accident victims have been reported. [5][6][7]13) However, spinal CSF leakage after motor vehicle accidents is not accepted as a clinical entity, mainly because of the differences in clinical and radiological findings compared to SIH. 1,12) Radioisotope cisternography has limited spatial resolution, so there is persistent and probably unfair mistrust in the diagnosis of spinal leaks after motor vehicle accidents.…”

An Integrated Model of Chronic Whiplash-Associated Disorder

“…45 While the published literature includes evidence in support of such lesions, several have been subsequently refuted, 74,75 and none have achieved the mantle of "silver bullet lesion." It has become clear that purely tissue-based models are unable to satisfactorily explain the experience and presentation of WAD.…”