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Introduction

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Functional Neuroimaging in Whiplash Injury

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Abstract

Patients with persisting symptoms after a whiplash injury (the so-called late whiplash syndrome) are often left alone. However, their complaints are not only limited to neuropathic pain in the head and neck region, but there are also symptoms, which proceed from the brain. These brain symptoms comprise vertigo, dizziness, tinnitus, concentration, attention, and memory disturbances; also visual problems such as blurred vision and oscillopsia can occur. Whiplash injury is one of the most frequent motor injuries; its incidence in the industrialized countries is estimated up to 3.8 cases per 1000 inhabitants per year, and up to 50% of patients develop persistent symptoms, making whiplash injury not only a prevalent but also costly challenge of today. Rear-end car collisions are the most frequent causes of whiplash injury, and only low speeds between 10 and 20 km/h are necessary to cause large acceleration forces on the head. The usual methods for the diagnosis of whiplash injury—like the neurological investigation or radiography of the cervical spine—unfortunately forget that the brain (alike the cervical spine) can be damaged by an acceleration trauma. Therefore, research methods are necessary, which objectively represent the condition of the brain. Conventional radiological imaging like computerized tomography or magnetic resonance tomography of the brain can, however, only represent the morphological (anatomical) structures and not also the possible functional cerebral alterations, as caused by whiplash injury. By contrast, the relatively new methods of nuclear medicine, such as single-photon emission tomography or positron emission tomography, currently offer the only possibility of imaging such functional changes.

Arma virumque cano, Troiae qui primus ab oris

Italiam fato profugus Lavinaque venit

litora – multum ille et terris iactatus et alto

vi superum, saevae memorem Iunonis ob iram,

multa quoque et bello passus, dum conderet urbem

inferretque deos Latio – genus unde Latinum

Albanique patres atque alta moenia Romae.

(“I sing of arms and the man, who—exiled by fate—first came from the Trojan coasts to Italy and the Lavine shores; was much smitten on land and sea by violence from Heaven, through cruel Juno’s unforgiving wrath, and suffered much in war, until he could found the city and bring over his gods to Latium, from where arose the Latin race, the fathers of Alba and the high walls of Rome.”)

Publius Vergilius Maro (70–19 B.C.), Aeneïs

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Notes

  1. 1.

    The cervical spine is a statically complicated structure in which muscles and ligaments attempt to build up axial pressure in all postures. In flexion and extension positions, the load that can be absorbed by the cervical spine is reduced and amounts to 500 kg in flexion and 100 kg in extension without damaging the intervertebral disc (Gareiss et al. 2020). In our book, however, we would like to focus on the skull and the brain and refer to other relevant literature on the cervical spine and its changes after a whiplash injury.

  2. 2.

    “The cranial symptoms mainly consist of:

    1. 1.

      Headache, preponderantly occipitally;

    2. 2.

      Vertiginous disturbances, which occur every moment when the patient turns his or her head, and which normally are not accompanied by any clear modification of instrumental vestibular tests;

    3. 3.

      Tinnitus;

    4. 4.

      Visual disturbances, which prevent the patients from reading a long time, make them believe that their sight has fallen; these disorders often lead them to the oculist, who does not generally observe any objective change in vision, because he examines the patient at rest, but only fatigue can show the disorder.” (Barré 1926).

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  1. Peter Osypka Institute of Medical Engineering, Faculty of Electrical Engineering, Medical Engineering and Computer Science, Offenburg University, Offenburg, Baden-Württemberg, Germany

    Andreas Otte

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Otte, A. (2022). Introduction. In: Functional Neuroimaging in Whiplash Injury. Springer, Cham. https://doi.org/10.1007/978-3-030-91255-0_1

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  • DOI: https://doi.org/10.1007/978-3-030-91255-0_1

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