Cervical whiplash syndrome. Hyperextension-hyperflexion injury

Cervical Whiplash Syndrome: A Case Report of a Work Accident

Cervical whiplash syndrome (CWS) or whiplash syndrome is a highly debated concept because there is still no consensus on its definition -- symptoms are usually very severe but the pain's root cause is typically uncertain. Clinical investigation and detailed radiology seldom identify a specific pathology. Thus, soft tissue injury is generally considered the most likely explanation for the symptoms, although it is difficult to confirm, even by MRI. We describe the clinical case of a physical education teacher who suffers an accident in one of her classes. The following day she is assessed at the emergency department and, after undergoing a radiological study of the cervical spine, she is diagnosed with straight cervical spine (kyphosis). She is observed again seven days later due to persistent pain but sent home with unchanged indications for rest and medication. After that her cervicobrachialgia progressively worsens, limiting her left shoulder active mobility and leading to associated muscle atrophy (in addition to a burnout syndrome). Several years after she is considered to have a total permanent disability. Finally, the authors propose that CWS should be approached according to the post-traumatic bodily injury evaluation methodology, suggesting some interventions.

Application of postmortem MRI for identification of medulla oblongata contusion as a cause of death: a case report

Whiplash injury is common in traffic accidents, and severe whiplash is characterized by cervical spinal cord injuries with cervical dislocation or fracture, that can be diagnosed by postmortem computed tomography (PMCT), postmortem magnetic resonance (PMMR), or conventional autopsy. However, for cervical spinal cord injury without fracture and dislocation, PMMR can be more informative because it provides higher resolution of soft tissues. We report the case of a 29-year-old male who died immediately following a traffic accident, in which the vehicle hit an obstacle at a high speed, causing deformation of the bumper and severe damage of the vehicle body. PMCT indicated no significant injuries or diseases related to death, but PMMR showed patchy abnormal signals in the medulla oblongata, and the lower edge of the cerebellar tonsil was herniated out of the foramen magnum. The subsequent pathological and histological results confirmed that death was caused by medulla oblongata contusion combined with cerebellar tonsillar herniation. Our description of this case of a rare but fatal whiplash injury in which there was no fracture or dislocation provides a better understanding of the potentially fatal consequences of cervical spinal cord whiplash injury without fracture or dislocation and of the underlying lethal mechanisms. Compared with PMCT, PMMR provides important diagnostic information in forensic practice for the identification of soft tissue injuries, and is therefore an important imaging modality for diagnosis of whiplash injury when there is no fracture or dislocation.