ASN » Whiplash Injury

Neurootological findings in patients, suffering from occipital skull fractures

julia — Thu, 03 Jul 2008 17:46:15 +0000

Skull traumas play an important roll in neurootological expertise writing. Skull traumas may occur at the rhinobasis, i.e. frontally, at the otobasis, i.e. laterally as well as from behind, i.e. occipitally. For this paper we have elected 26 cases of occipital skull fractures which were verified by radiology. It is known that the shockwaves of an occipital skull fracture does not only lead to local tissue damages in the neighbouring occipital lobe and/or cerebellum. But pressure waves may induce contrecoup effects at the frontal lobe and at the brainstem.

Due to the brainstem involvement we find a higher rate of vertigo complaints and of vertigo releasing factors in our randomly selected sample of 26 cases. The nausea complaints are lagging behind the vertigo complaints. The vertigo complaints are long-lasting. There also is an elevated percentage of oculomotor regulating disturbances with double vision and oscillopsia. The elevated percentage of anosmia must be explained by a contrecoup effect. Approximately half of the sample is suffering from tinnitus and subjective hearing losses.

In equilibriometry by means of polygraphic ENG we found much elevation in spontaneous nystagmus in lying position more then in sitting position. By means of the trinary coded caloric Claussen butterfly we detected 55% of pathology. The trinary stepping CCG is not as sensitive as it only detected in 47,3% of pathology. The complaints about a subjective hearing loss are more intensively objectivated by speech audiometry than by pure tone audiometry.

Tinnitus due to irritations of the cervical spines

julia — Mon, 23 Jun 2008 22:19:02 +0000

Tinnitus due to irritations of the cervical spines

and the neck

High incidence rates of functional neurootological disorders containing vertigo and tinnitus are found in the group of head-neck-trauma patients . This also is important in cases of musculo-skeletal dysfunctions like neck dystonus and cervical diseases. These groups are seen to form subgroups in which the patient’s neurootological status is differently exhibiting failures in the vestibular together with the acoustic tests .

This chapter of modern medicine is very important due to the after effects of head and neck trauma. The head together with the neck forms a short stump pendulum, which already at crash velocities of 8 km/h and higher leeds to hefty and unexpected hyperflections and/or hyperextensions of the head, even in those passengers of the vehicle, who are secured by belts.

As most of the longlasting symptoms after whiplash injuries of the type of the late whiplash injury syndrome belong into the field of neurootology, like vertigo, nausea, dystaxia, tinnitus, hearing loss, taste and smell diseases.

The findings are presented with respect to case reports as well as with statistics.

Whiplash Injury: Frequent Brain Lesions Studied Through Brain Electric Tomography – LORETA –

admin — Fri, 06 Jun 2008 20:01:28 +0000

A total of 46 patients have been chosen from our “Neurofisiología Oftalmológica” Data Bank with whiplash injury – Type 4 . Cervico-encephalic syndrome.

They were studied with S-Low Resolution Brain Electric Tomography (S-LORETA), and their results were compared vs. 100 normal patients.

Using Loreta and SNPM in our patients allow us to determine which are the most affected areas, and therefrom the cybernetic mechanism involved in the trauma.

The areas with highest activity of Delta and Theta type are located, in every patient, in frontal zones, BA 10 and BA 11, indicating independently of the whiplash, if it has been posterior of frontal.

The second phenomenon observed in all patients is irritation of temporal and parietal areas prevailing towards left BA 42, 22, and 43, appearing Beta 1 and Beta 2 rhythm.

The symptomatology of these patients can be explained and treated counting on diagnostic methods capable of demonstrating lesions in different brain areas.

Alterated head stabilization control during walking in whiplash

admin — Mon, 01 Jan 2007 00:00:00 +0000

Vestibular system is primarily dedicated in keeping balance and field of view stable. However many pathologies, especially whiplash injuries, frequently reduce vestibular control with social and economical relevance.
Many clinical and instrumental tests are used to analyze posture and gait improving the diagnosis of vestibular disorders. Among instrumental tests, CranioCorpoGraphy (CCG) is an efficient test to screen equilibrium functions, even if it is mostly based on qualitative information.
Here a 3D digital CranioCorpoGraphy is showed: it assesses the 3D movements and rotations of head and trunk rigid bodies, giving an exhaustive clinical information.
23 healthy and 10 whiplash subjects were asked to perform a stepping test on a foam, with closed eyes and the arms behind the back. Furthermore the frequency of the step was decided by the subject himself and the duration of the test was standardized at 35 seconds or 60 steps. The results show statistically significant differences between whiplash and healthy subjects (i.e. Instability parameter of whiplash people increases of at least 65% with respect to healthy people). These differences allow to develop a coefficient of performance (able to summarize the global performance of the test executed by the subjects) which well discriminates whiplash from healthy subjects.

Manual/musculoskeletal medicine in the treatmento of vertigo

admin — Sun, 01 Jan 2006 00:00:00 +0000

Vestibular nuclei receive signals from the skin, muscle, and viscera, although the pathways conveying these nonlabyrinthine inputs to the vestibular nucleus neurons are unknown.
Experimental data show that an anatomical substrate is present for somatosensory and visceral inputs to influence the activity of cells in the autonomic region of the vestibular nuclei and suggest that these signals are primarily transmitted through brainstem relay neurons. This is the functional substrate of Sensory-Motor Re-programming that is possible to obtain by means of manual techniques, both low amplitude high velocity (manipulations) and high amplitude low velocity.
In the paper we will describe indications of manual techniques in vestibular rehabilitation.

Approccio diagnostico ai disturbi dell’equilibrio negli esiti di colpo di frusta

admin — Sun, 01 Jan 2006 00:00:00 +0000

The goal of this work is to study the vestibular system of whiplash people using a 3D dCCG system. A new experimental set-up, based on optoelettronic technique, was developed to evaluate the 3D pattern of movement of head and trunk in different experimental set-ups. The exam protocol is very close to the classical one with some changes. The frequency of the steps is decided by the subject and not pre-arranged. Moreover the stepping tests is changed too: in dCCG there is a complete deprivation of sensorial afferents while in this case the parameters are evaluated in different conditions such as the complete deprivation of the sensorial afferents, the deprivation of some sensorial afferents or the presence of all the sensorial afferents. Furthermore the subject must take his hands and arms behind the back.

The displacement and rotation of the two rigid bodies head and trunk were analyzed to introduce new parameters with respect to the 2D dCCG. So 6 markers were adopted: three were put on an helmet placed on the head, two on the left shoulder and one on the right shoulder.

Subjects were asked to step on the spot in a more natural way and to standardize the length of the tasks, the test finished after almost 60 steps and 35 seconds.

Whiplash people executed four tests: open eyes, closed eyes, with and without the carpet on the floor. The considered parameters were extrapolated and generalized starting from those generally obtained by the 2D analysis, but trying to assess more the behaviour of the head and trunk (thought as two rigid bodies), than considering the trajectory of each marker. In particular the Index of Coordination, speeds (global with its lateral, vertical and longitudinal components), rotation angles (in the frontal, horizontal and sagittal plane) and displacements of the head and trunk were analyzed and compared with the normalcy databases.

Vestibular rehabilitation in whiplash injuries

admin — Thu, 01 Jan 2004 00:00:00 +0000

Whiplash injury can be defined as a non-contact rapid acceleration-deceleration head-neck trauma during which the kinematics of the cervical spine are completely disrupted. Because of the impact a sudden violent head retro-flexion is followed by an as much as violent head antero-flexion.
The therapy influenced Tonic muscles by increasing labyrinthine percentage and induced a reduction in activity of Phasic muscles by decreasing Somatosensorial and Visive Percentage

Quantitative evaluation of stepping test data of patients with whiplash through digital craniocorpography

admin — Wed, 01 Jan 2003 00:00:00 +0000

Digital-CranioCorpoGraphy (dCCG) can study the Equilibrium System through simple experimental procedures. The instrumentation records the movements of the head and the trunk of the patient suffering from whiplash syndrome who performs a motor task (Stepping Test).

To quantitatively evaluate patients motor ability and their instability 25 healthy people were selected and analyzed. Their data were compared with 33 whiplash patients who performed the Stepping Test. A set of parameters computed by the dCCG has been chosen to describe the subjectsí performance. These values have been statistically compared among the healthy and the pathological samples on the basis of the time elapsed from trauma (Time From Trauma > or < of 6 months) and the observed morphological pattern of motion.
Results demonstrates that dCCG is able to discriminate the considered groups and a clinical interpretation of these data has confirmed the reliability of the dCCG as a useful procedure for investigating whiplash patients

The acupuncture treatment in whiplash injury

admin — Wed, 01 Jan 2003 00:00:00 +0000

In this study we evaluated the postural changes after acupuncture treatment in a group of 27 patients with balance disorders caused by cervical torsion due to Whiplash Injury (WI). The acupuncture treatment consisted of 3 sessions (one weekly session for 3 weeks) during which the acupuncture points Bladder 10 and Gall Bladder 20. VB were stimulated by means of piercing with needles, and manipulating the needles for 20 seconds. Each patient underwent posturographic evaluations before and just after each session of acupuncture. The posturographic tests were performed with open eyes, closed eyes and closed eyes with retroflexed head (CER). As a control group, we used 25 patients complaining of the same symptoms as the study group due to WI, but treated with FANS, myorelaxing and physiotherapy. The control group also underwent posturographic tests once a week for three weeks. We observed a significant difference between the two groups regarding the reduction of the CER Length of the statokinesigram just before each session of acupuncture and reduction of the frequency oscillations (FFT) of the patients on the sagittal plane in the study group, in CER, whereas in the control group we observed a progressive increase in these values. The high percentage of positive results in WI patients leads us to advocate the acupuncture for balance disorders due to cervical pathology.

Neurootological findings in 131 whiplash patients

admin — Wed, 01 Jan 2003 00:00:00 +0000

Whiplash patients referred for neurootological investigation underwent the full test battery including electronystagmography for spontaneous and positional nystgmus, ocular smooth pursuit, saccades, caloric responses and visual suppression during the caloric response. In most patients visual suppression was also performed using a broad frequency rotatory chair. Dynamic posturography was performed, in some patients even with head position provokation and the pursuit test using a broad frequency program. Pure tone audiometry was done.
The mean age was 35 years, 88 were women and 43 men. Several years had passed since the accident, ususally a rear end or side collision in cars. The severity of WAD was Quebec II-III.
Most pathology was found in the sinusoidal ocular pursuit test (31%) and the broad frequency randomized one (71%). The visual suppression was pathological in 18%, but 47% if performed broadfrequently. Findings in sponaneous or gaze nystagmus were infrequent. In 42% there were some findings even in the videooculoscopy. The posturography had a significant number of positive findings, more so with the neck turned.
The findings indicate that neurootological investigation is of value. The disturbances may be caused by a neck and/or brainstem lesion.