References: Whiplash Stroke; Volume 3 Issue 6

1. AUTHOR	Showalter-W, Esekogwu-V, Newton-K-I, Henderson-S-O.
INSTITUTION	Department of Emergency Medicine, LAC + USC Medical Center 90033, USA.
TITLE	Vertebral artery dissection.
SOURCE	Acad-Emerg-Med 1997 Oct, VOL: 4 (10), P: 991-5, ISSN: 1069-6563 22 Refs.
ABSTRACT	Vertebral artery dissections (VADs) following a variety of minor traumatic mechanisms have been previously reported. This article reports 2 cases of VAD with delayed recognition following motor vehicle collisions (MVCs). The first VAD patient developed major neurologic abnormalities 28 hours after an MVC. The second VAD patient presented with 3 weeks of neck and head pain beginning 8 weeks after an MVC and subsequent chiropractic manipulation. The anatomy and pathophysiology of VAD are reviewed. Early ED recognition prior to the onset of major neurologic deficits (e.g., paresis, dysarthria, ataxia, or altered mental status) is emphasized. An algorithm for the ED management of the entity is suggested. Author.

2. AUTHOR	Hung-K-H, Chang-M-H, Lai-P-H, Shy-C-G, Lo-Y-K.
INSTITUTION	Department of Internal Medicine, Veterans General Hospital-Kaohsiung, Taiwan, R.O.C.
TITLE	Traumatic dissection of the vertebral artery: a case report.
SOURCE	Chung-Hua-I-Hsueh-Tsa-Chih (Taipei) 1997 Mar, VOL: 59 (3), P: 210-5, ISSN: 0578-1337.
ABSTRACT	This report concerns a patient suffering from a severe neck pain on the third day after a traffic accident. This condition was followed by a lateral medullary infarction on the next day. One week later, he was transferred to this hospital and dissection of the vertebral artery was disclosed. It should be emphasized that in case of acute cervical spine injury or severe neck pain after a major trauma, vertebral artery dissection should be considered, as its early diagnosis may have crucial therapeutic implications. In addition, the advantages of the combination of magnetic resonance imaging and magnetic resonance angiography as diagnostic tools-of-choice are emphasized. Author.

3. AUTHOR	Barontini-F, Maurri-S.
INSTITUTION	Clinica Neurologica III, Universita di Firenze.
TITLE	Isolated amnesia following a bilateral paramedian thalamic infarct. Possible etiologic role of a whiplash injury.
SOURCE	Acta-Neurol (Napoli) 1992 Apr, VOL: 14 (2), P: 90-102, ISSN: 0001-6276.
ABSTRACT	A previously healthy 45 years old carpenter suffered a whiplash injury in a road accident on July, 18th, 1990. He continued to work in spite of occipital headache, episodic sweatening and slight hypersomnia. On August, 8th, 1990 while parking his car into the deck of a ferry-boat he was found slightly confuse and markedly amnestic. A post-traumatic subdural haematoma was suspected. As a CT-scan of the brain was normal, a toxic encephalopathy or an hysterical amnesia were proposed. However, a MRI performed on August, 22th, 1990, apart from a small infarct in the white matter of the left occipital lobe, showed two small bilateral paramedian thalamic infarcts. The last lesions usually follow a thrombotic or embolic occlusion of the "basilar communicating artery" (BCA) belonging to the vertebro-basilar system. The possible etiologic relationship between this syndrome and the previous whiplash injury has been considered. Six months later, while a control MRI showed a reduction of the brain lesions, a neuropsychological examination revealed a slight improvement of memory dysfunction evident also at a distance of further 6 months. This case is interesting because it tests the high sensitivity of MRI in amnestic syndromes and because of the possible role of a whiplash injury in the etiology of BPTI. Author.

4. AUTHOR	Viktrup-L, Knudsen-G-M, Hansen-S-H.
INSTITUTION	Department of Neurology, Hillerod Hospital, Copenhagen, Denmark.
TITLE	Delayed onset of fatal basilar thrombotic embolus after whiplash injury.
SOURCE	Stroke 1995 Nov, VOL: 26 (11), P: 2194-6, ISSN: 0039-2499.
ABSTRACT	BACKGROUND: Whiplash injuries are generally seen after rear-end rather than frontal car collisions. Previous reports have documented death up to 8 days after serious whiplash injury. We report a case of lethal basilar thrombotic embolus that occurred 2 months after the patient's injury in a collision. CASE DESCRIPTION: After whiplash trauma in a car accident, a 50-year-old taxi driver suffered from headache and episodic visual disturbances. Two months after the accident he suddenly lost consciousness and was admitted to the hospital. A CT scan performed at that time was indicative of basilar thrombosis. The patient died 3 days later. The autopsy revealed a thrombosis in the right vertebral artery and a thrombotic embolus in the basilar artery. Microscopically, a lesion of the right vertebral artery was found at the level of the atlantoaxial joint. CONCLUSIONS: We conclude that the whiplash injury caused a lesion of the right vertebral artery, leading to repeated transient ischemic attacks and finally to a fatal basilar thrombotic embolus. We suggest that in patients with disturbances of the vertebrobasilar circulation, attention should be paid to occurrence of neck trauma in the preceding 3 months. Further, anticoagulant therapy should particularly be considered in patients who after suffering neck injuries develop signs of transient ischemic attacks with origin from the posterior cerebral circulation. Author.

WHIPLASH STROKE