Abstract
Whiplash injury is not only limited to neck injury but also brainstem injury that does not involve direct damage to the neck or head. The symptoms of whiplash injury are polymorphous, with the most common complaints being cervical pain, headache and scapulodynia. Vertigo and dizziness are also reported in 25–50% of the cases. In otoneurologic studies, magnetic resonance angiography (MRA) is used for the evaluation of vertebrobasilar hemodynamics in patients who complain of dizziness and vertigo. It is reported that vertebrobasilar artery insufficiency (VBI) leads to brainstem and cerebellar ischemia and infarction following cervical manipulation. Here we examined the correlation between vertigo or dizziness and the right and left side difference in vertebral arteries after whiplash injury using MRA. We studied 20 patients who complained of neck pain with vertigo or dizziness after whiplash injury and 13 healthy volunteers as a control. In the control group, abnormal MRA findings in the vertebral arteries such as occlusion, stenosis or slow blood flow were seen in 77% of the cases. In the patient group, abnormal MRA findings were seen in 60%. The side difference in blood flow was 3.5±2.5 cm/s in the control group and 6.1±3.0 cm/s in the patient group. Our findings suggest that some subjects with persistent vertigo or dizziness after whiplash injury are more likely to have VBI on MRA. VBI might be an important background factor to evoke cervical vertigo or dizziness after whiplash injury. The side difference between the two vertebral arteries could cause a circulation disorder in the vertebrobasilar system after whiplash injury. However, the VBI on MRA itself was also seen in the control group, and thus it is not clear whether it is due to whiplash injury in the patient group.
Similar content being viewed by others
References
Arai M, Higuchi A, Umekawa J et al (1999) The efficiency of MRA in the diagnosis and vertigo-prediction of vertebrobasilar insufficiency and atherosclerosis. J Otolaryngol Jpn 102:925–931
Bosworth DM (1859) Editorial. J Bone Joint Surg 41-A:16
Chester JB Jr (1991) Whiplash, postural control, and the inner ear. Spine 16:716–720
Crow H (1928) Injuries to the cervical spine. Presentation to the annual meeting of Western Orthopaedic Association, San Francisco
Endo K, Ichimaru K, Imakiire A, Shimura H (2000) Cervical vertigo after hair shampoo treatment at a hairdressing salon. Spine 25: 632–634
Friedman D, Flanders A, Thomas C, Millar W (1995) Vertebral artery injury after acute cervical spine trauma: rate of occurrence as detected by MR angiography and assessment of clinical consequences. Am J Radiol 164:443–447
Fujita N, Yamanaka T, Ueda T et al (1998) MRI test in hemodynamic vertebrobasilar insufficiency. Acta Otolaryngol (Stockh suppl) 533:57–59
Gay JR, Abbott RH (1953) Common whiplash injuries of the neck. JAMA 152:1698–1704
Haldeman S, Kohlbeck J, McGregor M (1999) Risk factors and precipitating neck movement causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation. Spine 24: 785–794
Hinoki M (1985) Vertigo due to whiplash injury: a neurological approach. Acta Otolaryngol Suppl (Stockh suppl) 419:9–29
Keggi K, Grnger D, Southwick WO (1966) Vertebral artery insufficiency secondary to trauma and osteoarthritis of the cervical spine Yale. J Biol Med 38:471–478
MacNab I (2002) Acceleration injury of the cervical spine. J Bone Joint Surg [Br] 84-B:807–811
Nakagawa T, Yamane H, Nakai Y Shigeta T, Takashima T (1998) Evaluation of vertebrobasilar artery system by magnetic resonance angiography in the diagnosis of vertebrobasilar insufficiency. Acta Otolaryngol 538:54–57
Nibu K, Cholewicki J, Panjabi M, Babat LB, Grauer JN, Kothe R, Dvorak J (1998) Dynamic elongation of the vertebral artery during an in vitro whiplash simulation. Eur Spine J 7:263–265
Non-life Insurance Rating Organization of Japan (2003) Profile of automobile insurance (in Japanese), Takayama, Tokyo
Nomura Y, Hamada N, Saito Y, Yoshida S, Endo S, Shigihara S, Kida A (1998) Two cases of cerebellar infarction in the territory of the PICA due to cervical occlusive injury. Equilib Res 57:608–614
Okawara S, Nibbelink D (1974) Vertebral artery occlusion following hyperextension and rotation of the head. Stroke 5:640–642
Otte A, Mueller-Brand J, Fierz L (1995) Brain SPECT findings in late whiplash syndrome. Lancet 345:1513–1514
Pettersson K, Hildingsson C, Toolanen G, Fagerlund M, Bjornebrink J (1994) MRI and neurology in acute whiplash trauma. No correlation in prospective examination of 39 cases. Acta Orthop Scand 65:525–528
Ryan GMS, Cope S (1995) Cervical vertigo. Lancet 2:1355–1358
Shimizu K, Matsuda T, Sakurai T, Fujita A, Ohara H, Okamura S, Hashimoto S, Mano H, Kawai C, Kiri M (1986) Visualization of moving fluid: quantitative analysis of blood flow velocity using MR imaging. Radiology 159:195–199
Spitzer WO, Skovron ML, Salmi LR, et al (1995) Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management. Spine (suppl) 8:20
Vibert D, Hausler R (2003) Acute peripheral vestibular deficits after whiplash injuries. Ann Otolo Rhinol Laryngol 112:246–251
Voyvodic F, Dolinis J, Ryan GA, Slavotinek JP, Whyte AM, Hoile RD, Taylor GW (1997) MRI of car occupants with whiplash injury. Neuroradiology 39:35–40
Watanabe M, Kakahashi A, Hashizume Y, Motegi Y, Furuse K (1992) The correlation between vertebral artery asymmetry and pontine infarction—an MR angiography study. Clin Neurol 32:708–712
Wenngren B-I, Pettersson K, Lowenhielm G, Hildingsson C (2002) Eye motility and auditory brainstem response dysfunction after whiplash injury. Acta Otolaryngol 122:276–283
Yarnell PR, Rossie GV (1988) Minor whiplash head injury with major debilitation. Brain Inj 2:255–258
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Endo, K., Ichimaru, K., Komagata, M. et al. Cervical vertigo and dizziness after whiplash injury. Eur Spine J 15, 886–890 (2006). https://doi.org/10.1007/s00586-005-0970-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-005-0970-y