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IN WHIPLASH INJURIES
Professeur invité
à l’Université de LIEGE
Clinical spectrum of whiplash-associated disorders as
proposed by the Quebec Task Force (1995)
Grade Presumed pathology Clinical presentation
I Microscopic or multimicroscopic Usually presents to a doctor
lesion more than 24 h after trauma
Lesion is not serious enough to
cause muscle spasm
II Neck sprain and bleeding around soft Usually presents to a doctor in
tissue (articular capsules, ligaments, the first 24 h after trauma
tendons, and muscles) Nonspecific radiation to the
Muscle spasm secondary to soft head, face, occipital region,
issue injury shoulder, and arm from soft
tissues injuries
Neck pain with limited range of
motion due to muscle spasm
III Injuries to neurologic system by Presents to a doctor usually
mechanical injury or by irritation within hours after the trauma
secondary to bleeding or Limited range of motion
inflammation combined with neurologic
symtoms and signs
Clinical classification on whiplash-associated disorders
proposed by the Quebec Task Force (1995)
Grade Clinical presentationa
0 No complaints about the neck
No physical sign(s)
I Neck complaint of pain, stiffness, or tenderness
No physical sign(s)
II Neck complaint and
Musculoskeletal sign(s): decreased range of motion and point
tenderness
III Neck complaint and
Neurological sign(s): decreased or absent deep tendon
reflexes, weakness, and sensory deficits
IV Neck complaint and
Fracture or dislocation
a
Symptoms and disorders that can be manifest in all grades include deafness, dizziness, tinnitus, headache, memory
loss, dysphagia, and temporomandibular joint pain. Grades I-II are the limits of terms of reference of the Quebec Task
Force on Whiplash-Associated Disorders
Aetiology
Lesions of Soft Tissues of the Neck
Lesions of peripheral nerves
⇒ Dizziness
Aetiology
Vestibular lesions
– Benign Positional Vertigo
– Otolithic vertigo without cupulolithiasis
– Labyrinthin Concussion
– Perilymphatic fistula
– Hydrops endolymphatic delayed
⇒ Vertigo
Aetiology
Central Nervous System Lesions
– Vascular problems
± Wallenberg syndrom
– Dissection of vertebral arteries
– Trauma
– Chiropracty
– Contusion of vestibular nuclei or
vestibular central pathways
– Phobic secondary postural syndrom
⇒ Vertigo
Phobi c vert igo
The syndrome of phobic postural vertigo, described by
Brandt in 1991, is characterised by combination of
situationally triggered panick attacks including vertigo and
subjective postural and gait instability and the fear of
imminent death. Patients complain of vertigo rather than
anxiety and feel physically ill. This syndrome should be
explained by the hypohesis that an impairment of the
space constancy mechanism leads to partial uncoupling of
the efferent copy for active head movements. This triggers
phobic attacks. Allowing to Brandt it represents the third
cause of vertigo in a specialised consultation. Clinical
experience does point the existence of persons with
positional vertigo who are conditioned to be dizzy, with or
without objective signs of vertigo. At present, this syndrom
is of uncertain validity or significance as it lacks a specific
test for diagnosis.
- benign paroxysmal positioning vertigo
- immediate
- late onset : days to several weeks
- slow degeneration of the otolith
organ after labyrinth
concussion
- settling of dislodged otoconia in
the utricular cavity before
entering the semicircular canal
- time needed for several pieces
of otoconia to form a cloth
(canalolith) to become causative.
Gacek Hypot hesi s
The pathophysiological mechanism responsible for a
position-induced vestibulo-ocular response in this
disorder is neural, rather than mechanical stimulation
of the sense organ. Loss of the inhibitory action of
otolith organs on canal activation caused by
degeneration of otolith neurons (saccular, utricular) is
a possible explanation of the brief canal response
induced by the positional stimulus.
TREATMENT
1. Dizziness from soft tissues lesions or
peripheral nerves:
We refer to the chapter
« Whiplash Inury : Orthopaedic and
Rehabilitative Approach to Neck Pathology »
P. Sibilla, S. Negrini, S. Atanas
In Whiplash Injury. Diagnosis and Treatment.
Springer Verlag.
Summary of Sibilla and al. classification
- Manipulation : no
- Massage : to reduce muscular contraction
- Traction : danger to damage soft tissues
- Acupuncture : on some cases.
TREATMENT
2. VERTIGO
Beni gn paro xysm al verti go
change of position
from to
standing
sitting, movements
change of position
from to
V.H.T.
Labyrinthin Concussion
V.H.T.
Peri lymphati c fistul a
- Rest
- In case of failure : surgery
Hydrops
- Medical treatment
Central Vertigo
- Drugs : - Vincamine
- Piracetam
- Ginkgo biloba
- Rehabilitation by exercises
Phobi c postur al syndrome
- Psychological approach
- Posture exercises
- Physiotherapy
OUR EXPERIENCE