Brain Lesions in Whiplash Patients

This report is an update of a previous study that found evidence of parieto-occipital perfusion deficits in the brains of whiplash patients. The question asked in this current report is: are lesions caused by direct or indirect trauma of the head or are they "elicited from lesions of pain-sensitive afferents from the upper cervical spine after whiplash injury of the neck?"

The authors compared 15 whiplash patients to 15 healthy controls. The whiplash patients were drivers at the time of the collision, and they were specifically chosen because they had their heads turned to the right at the moment of impact. All of the subjects were examined with single-photon emission tomography (SPET) scans.

The authors hypothesized that if head trauma was responsible for the cerebral lesions, they should only exist in one of two areas—the left frontal and the right parieto-occipital regions. They did indeed find lesions in these areas. They also, however, found areas of hypoperfusion in the left parieto-occipital region.

"As the patients were looking to the right side at the time of the accident, a contusion mechanism could be possible for the left frontal and the right parieto-occipital region, regardless of whether this was produced directly by hitting the head onto the steering wheel or by the acceleration forces producing indirect head impact. If whiplash injury were only a form of mild head injury with a contusion mechanism, the additional left parieto-occipital hypoperfusion in the above patients could not be explained. Therefore, we think that parieto-occipital hypoperfusion in whiplash patients may still be hypothesized to be elicited from lesions of neuroceptive afferents from the cervical spine. Of course, this does not mean that brain contusions need not be carefully evaluated, as additional contusion is well known to have an effect on clinical after injury."

Otte A, Goetze M, Mueller-Brand J. Statistical parametric mapping in whiplash brain: is it only a contusion mechanism? European Journal of Nuclear Medicine [Letter] 1998;25:306-312.