Whiplash, Cervical - Medical Research Abstracts

1. AUTHOR	Mayou-R, Bryant-B.
INSTITUTION	University Department of Psychiatry, Warneford Hospital, Oxford, UK.
TITLE	Outcome of 'whiplash' neck injury.
SOURCE	Injury 1996 Nov, VOL: 27 (9), P: 617-23, ISSN: 0020-1383.
ABSTRACT	Psychological factors have been alleged to be important in the course and outcome of 'whiplash' neck injury but there is little quantitative evidence. This study uses quantitative methods involving a prospective interview assessment to describe psychological and quality of life predictors, and 3 and 12 month outcome. Consecutive attenders to the Accident and Emergency department of a teaching district hospital with a clinical diagnosis of 'whiplash' neck injury were included and there were follow-up interviews at home. Neck symptoms were recorded, and there was a standard mental-state interview with added questions about post-traumatic symptoms and a semi-structured interview for disability and consequences for quality of life. There was a wide individual variation in course and outcome; the majority of subjects complained of persistent neck symptoms and a sizeable minority reported specific post-traumatic psychological symptoms (intrusive memory, phobic travel anxiety), similar to those described by patients suffering multiple injuries. Social impairment, including effects on travel, were considerable in one-quarter. Reports of persistent neck symptoms were not associated with any baseline psychological variables or with compensation proceedings; psychological factors appeared to be more important in determining the extent of social impairment. We conclude that travel, social and psychological morbidity is substantially greater than previously recognized. Author.

2. AUTHOR	Mayou-R, Radanov-B-P.
INSTITUTION	Department of Psychiatry, Warneford Hospital, Oxford, UK.
TITLE	Whiplash neck injury.
SOURCE	J-Psychosom-Res 1996 May, VOL: 40 (5), P: 461-74, ISSN: 0022-3999 60 Refs.
ABSTRACT	Whiplash, or post-traumatic, neck injury is an increasingly frequent clinical problem. Large numbers of patients present with both acute and chronic physical symptoms. It has frequently been alleged that psychological factors and social variables (especially the influence of possible compensation) are major causes of persistent physical complaints and disability. There have been few methodologically satisfactory studies, and very little attention has been paid to mental state and quality of life issues. Epidemiology, clinical features, prognosis, and aetiology are all reviewed with a special emphasis on psychological outcome and variables. It is argued that such factors are as important in relation to whiplash injuries as are other physical conditions, especially musculoskeletal disorders. In addition, specific posttraumatic symptoms are common but usually unrecognized. Author.

3. AUTHOR	Radanov-P, Sturzenegger-M, Di-Stefano-G.
INSTITUTION	Psychiatrische Universitatspoliklinik, Bern.
TITLE	(Prediction of recovery from dislocation of the cervical vertebrae (whiplash injury of the cervical vertebrae) with initial assessment of psychosocial variables). TT Vorhersage der Erholung nach HWS-Distorsion (Schleudertrauma der HWS) mit initial erhobenen psychosozialen Variablen.
SOURCE	Orthopade 1994 Aug, VOL: 23 (4), P: 282-6, ISSN: 0085-4350.
ABSTRACT	The purpose of the present study was to investigate the predictive relationship between psychosocial factors and the course of recovery in patients with whiplash injury. A non-selected sample of 117 subjects satisfying to a clear definition of the syndrome was assessed early after trauma (mean 7.4 +/- 4.2 days) and again at 3, 6, and 12 months. Initial evaluation included subjective complaints (including timing of symptom onset and initial pain intensity) and a large number of psychosocial factors (e.g., self-ratings of well- being, personal and family history, personality traits, and cognitive functioning). Rate of recovery was assessed at follow-ups. One year after initial trauma patients were divided in two groups (recovered and still symptomatic) and compared with regard to initial findings. Finally, a regression analysis was performed with all baseline variables, employing groups (recovered vs symptomatic) as factor variables. Patients who remained symptomatic at 1 year had significantly higher ratings of initial neck pain and headache, displayed a greater variety of subjective complaints, higher scores on the scale "nervousness" from the personality inventory, worse well-being score and poorer performance with regard to focussed attention. According to the regression analysis the following set of initial variables was in significant relationship with poor recovery at 1 year: higher age, complaint of sleep disturbances at initial investigation, and higher intensity of initial neck pain and headache. Author.

4. AUTHOR	Huber-A, Beran-H, Trenkler-J, Hager-A, Witzmann-A, Fischer-J.
INSTITUTION	Neurochirurgische Abteilung Wagner-Jauregg-Krankenhaus Linz.
TITLE	(Whiplash trauma of the cervical spine from the neurosurgical, traumatologic and psychologic viewpoint). TT Das Schleudertrauma der HWS aus neurochirurgischer, traumatologischer und psychologischer Sicht.
SOURCE	Neurochirurgia (Stuttg) 1993 Mar, VOL: 36 (2), P: 51-5, ISSN: 0028-3819.
ABSTRACT	Since the early 50's, whiplash injury has been a subject of intensive study in order to find out the genesis of this disease. Unfortunately, most of the studies were planned retrospectively and were based on inhomogeneous groups of patients. In our prospective study, we tried to keep the patient group homogeneous. 62 patients were examined neurologically and radiologically immediately after the accident. Furthermore, they underwent a psychological test, the so- called Freiburg personality profile. 6 months later the patients were checked again. On the basis on our findings, the suspected psychological influence has to be confirmed. Preexisting degenerative lesions of the cervical spine, also, are undoubtedly prognostic for longer-lasting symptoms. Author.

5. AUTHOR	Bohnen-N, Jolles-J, Verhey-F-R.
INSTITUTION	Department of Neuropsychology and Psychobiology, University of Limburg, Maastricht, The Netherlands.
TITLE	Persistent neuropsychological deficits in cervical whiplash patients without direct headstrike.
SOURCE	Acta-Neurol-Belg 1993, VOL: 93 (1), P: 23-31, ISSN: 0300-9009.
ABSTRACT	Persistent cognitive and neurasthenic complaints can be the consequence of a cervical whiplash injury. In contrast to otoneurological and orthopedic reports, neuropsychological studies on whiplash patients are scarce. We report disturbances of information processing and memory functions in two patients with a pure cervical whiplash injury with demonstrated central otoneurological abnormalities, whereas there was no evidence of intellectual deterioration or focal cortical deficits. The results suggest that the cognitive disturbances and neurasthenic symptoms may be part of one syndrome which appears to manifest itself under conditions of time pressure and distraction. Author.

6. AUTHOR	Ettlin-T-M, Kischka-U, Reichmann-S, Radii-E-W, Heim-S, Wengen-D, Benson-D-F.
INSTITUTION	University Clinics, Basel, Switzerland.
TITLE	Cerebral symptoms after whiplash injury of the neck: a prospective clinical and neuropsychological study of whiplash injury (see comments).
SOURCE	J-Neurol-Neurosurg-Psychiatry 1992 Oct, VOL: 55 (10), P: 943-8, ISSN: 0022-3050.
CM	Comment in: J-Neurol-Neurosurg-Psychiatry 1993 Dec; 56(12):1328-9.
ABSTRACT	Twenty one unselected patients with an acute whiplash injury of the neck had neurological and neuropsychological assessment, cervical x rays, EEG, BAEP, MRI, and an otoneurological examination within two weeks of the injury. Subjectively, 13 patients reported concentration deficits, 18 reported sleep disturbances, 9 had symptoms of depression, and 7 female patients told of menstrual irregularities. Neuropsychological examination revealed significantly lower performance in tests related to attention and concentration compared to sex, age and educational matched control subjects. Otoneurological examination showed abnormalities in 9 of 17 whiplash subjects. EEG showed questionable changes in 8 of 18 recordings. MRI and BAEP were normal in all patients. Repeat neuropsychological testing in 15 patients at three months showed that attention deficits had improved but were still shown in 12 of 14 and the concentration deficits in 8 of 13 patients. At one year all patients had returned to work, 16 to full and 5 to part time employment. In 4, cognitive dysfunction remained the only significant problem. These findings are discussed as being compatible with possible damage to basal frontal and upper brain stem structures after whiplash injury of the neck. Author.

7. AUTHOR	Radanov-B-P, Valach-L, Wittlieb-Verpoort-E, Dvorak-J.
INSTITUTION	Psychiatrische Universitatspoliklinik, Bern.
TITLE	(Neuropsychological findings following whiplash injury of the cervical spine). TT Neuropsychologische Befunde nach Schleuderverletzung der Halswirbelsaule.
SOURCE	Schweiz-Med-Wochenschr 1990 May 12, VOL: 120 (19), P: 704-8, ISSN: 0036-7672.
ABSTRACT	58 patients with whiplash injury of the cervical spine underwent formal testing with respect to self-rated cognitive impairment and processing of visual and auditory information. The results indicated disturbances in divided attention for auditory information, particularly in patients with so-called cervicoencephalic syndrome. Impaired attentional control was assumed to be relevant to processes of the working memory. Author.

8. AUTHOR	Radanov-B-P, Dvorak-J, Valach-L.
INSTITUTION	Psychiatrische Universitatspoliklinik Bern.
TITLE	(Psychological changes following whiplash injury of the cervical vertebrae). TT Psychische Veranderungen nach Schleuderverletzungen der Halswirbelsaule.
SOURCE	Schweiz-Med-Wochenschr 1989 Apr 29, VOL: 119 (17), P: 536-43, ISSN: 0036-7672.
ABSTRACT	To evaluate the frequently attributed psychogenic origin of symptoms following "whiplash" injury, 66 patients who had suffered such an injury underwent clinical and psychometric examination. Data were collected on subjective symptoms and their possible psychogenic origin and psychopathology. Personality profile, subjective well- being and cognitive impairment were evaluated. The amount of long- lasting psychopathological alterations was comparatively small. The results do not support the notion of a psychogenic origin for symptoms after "whiplash" injury; personality traits and psychopathology do not explain the nature of the complaints. Author.