PET with 18fluorodeoxyglucose and hexamethylpropylene amine oxime SPECT in late whiplash syndrome

Regional Homogeneity and Multivariate Pattern Analysis of Cervical Spondylosis Neck Pain and the Modulation Effect of Treatment

Objects: We investigated brain functional alteration in patients with chronic cervical spondylosis neck pain (CSNP) compared to healthy controls (HCs) and the effect of intervention. Methods: 104 CSNP patients and 96 matched HCs were recruited. Patients received 4 weeks of treatment. Resting-state fMRI and Northwick Park Neck Pain Questionnaire (NPQ) were collected before and after treatment. Resting state regional homogeneity (rs-ReHo) and multivariate pattern analysis (MVPA) were applied to (1) investigate rs-ReHo differences between CSNP patients and controls and the effect of longitudinal treatment and (2) classify CSNP patients from HCs and predict clinical outcomes before treatment using MVPA. Results: We found that (1) CSNP patients showed decreased rs-ReHo in the left sensorimotor cortex and right temporo-parietal junction (rTPJ), and rs-ReHo at the rTPJ significantly increased after treatment; (2) rs-ReHo at rTPJ was associated with NPQ at baseline, and pre- and post-treatment rs-ReHo changes at rTPJ were associated with NPQ changes in CSNP patients; and (3) MVPA could discriminate CSNP patients from HCs with 72% accuracy and predict clinical outcomes with a mean absolute error of 19.6%. Conclusion: CSNP patients are associated with dysfunction of the rTPJ and sensorimotor area. Significance: rTPJ plays on important role in the pathophysiology and development of CSNP.

PET and Single-Photon Emission Computed Tomography in Brain Concussion

This article offers an overview of the application of PET and single photon emission computed tomography brain imaging to concussion, a type of mild traumatic brain injury and traumatic brain injury, in general. The article reviews the application of these neuronuclear imaging modalities in cross-sectional and longitudinal studies. Additionally, this article frames the current literature with an overview of the basic physics and radiation exposure risks of each modality.

Altered Regional Cerebral Blood Flow in Chronic Whiplash Associated Disorders

There is increasing evidence of central hyperexcitability in chronic whiplash-associated disorders (cWAD). However, little is known about how an apparently simple cervical spine injury can induce changes in cerebral processes. The present study was designed (1) to validate previous results showing alterations of regional cerebral blood flow (rCBF) in cWAD, (2) to test if central hyperexcitability reflects changes in rCBF upon non-painful stimulation of the neck, and (3) to verify our hypothesis that the missing link in understanding the underlying pathophysiology could be the close interaction between the neck and midbrain structures. For this purpose, alterations of rCBF were explored in a case-control study using H₂¹⁵O positron emission tomography, where each group was exposed to four different conditions, including rest and different levels of non-painful electrical stimulation of the neck. rCBF was found to be elevated in patients with cWAD in the posterior cingulate and precuneus, and decreased in the superior temporal, parahippocampal, and inferior frontal gyri, the thalamus and the insular cortex when compared with rCBF in healthy controls. No differences in rCBF were observed between different levels of electrical stimulation. The alterations in regions directly involved with pain perception and interoceptive processing indicate that cWAD symptoms might be the consequence of a mismatch during the integration of information in brain regions involved in pain processing.

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Differences of rCBF were explored by PET in cWAD patients and healthy volunteers exposed to four conditions.

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Changes in rCBF were observed in cWAD patients in regions involved in pain perception and interoceptive sensory information.

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These changes might be the consequence of a mismatch in the integration of interoceptive stimuli in pain processing regions.

In the past, published work on chronic whiplash-associated disorders (cWAD) has caused much confusion and discussion, yet functional imaging methods such as positron emission tomography (PET) have demonstrated a variety of different significant alterations in the perfusion or glucose utilization of the brain. The present study, using PET and the perfusion marker, H₂¹⁵O, is a step forward in whiplash research. It shows changes in perfusion in regions directly involved in pain perception and interoceptive sensory information, such as the insular cortex, precuneus, and posterior cingulate, indicating a mismatch in the integration of interoceptive information in pain processing brain regions.

Clinical utility of SPECT neuroimaging in the diagnosis and treatment of traumatic brain injury: a systematic review

Purpose

This systematic review evaluated the clinical utility of single photon emission computed tomography (SPECT) in traumatic brain injury (TBI).

Methods

After defining a PICO Statement (Population, Intervention, Comparison and Outcome Statement), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria were applied to identify 1600 articles. After screening, 374 articles were eligible for review. Inclusion for review was focus on SPECT in the setting of mild, moderate, or severe TBI with cerebral lobar specificity of SPECT findings. Other inclusion criteria were comparison modalities in the same subjects and articles in English. Foreign language articles, SPECT studies that did not include comparison modalities, and case reports were not included for review.

Results

We identified 19 longitudinal and 52 cross-sectional studies meeting inclusion criteria. Three longitudinal studies examined diagnostic predictive value. The first showed positive predictive value increases from initial SPECT scan shortly after trauma to one year follow up scans, from 59% to 95%. Subsequent work replicated these results in a larger cohort. Longitudinal and cross sectional studies demonstrated SPECT lesion localization not detected by CT or MRI. The most commonly abnormal regions revealed by SPECT in cross-sectional studies were frontal (94%) and temporal (77%) lobes. SPECT was found to outperform both CT and MRI in both acute and chronic imaging of TBI, particularly mild TBI. It was also found to have a near 100% negative predictive value.

Conclusions

This review demonstrates Level IIA evidence (at least one non-randomized controlled trial) for the value of SPECT in TBI. Given its advantages over CT and MRI in the detection of mild TBI in numerous studies of adequate quality, and given its excellent negative predictive value, it may be an important second test in settings where CT or MRI are negative after a closed head injury with post-injury neurological or psychiatric symptoms.

The impact of mild closed head injury on involuntary saccadic adaptation: Evidence for the preservation of implicit motor learning

OBJECTIVE

Mild closed head injury (CHI) can impair performance on volitional saccades (fast eye movements), with poorer saccade accuracy being one of the principal deficits. Assessing a patient group with known deficits of volitional saccades, the authors investigated whether mild CHI similarly impairs the implicit adaptation of visually-guided (reflexive) saccades, an important process which maintains saccadic accuracy.

METHODS

Within 2 weeks following mild CHI, 30 patients and 30 matched controls were compared on a computerized paradigm, which artificially induced saccadic adaptation. In response to an initial stimulus, subjects made a saccade during which the stimulus was displaced centripetally causing the initial (primary) saccade to be inaccurate. While these intra-saccadic changes remained unnoticed by the subjects, the displacements gradually caused adaptive saccadic hypometria.

RESULTS

No differences in adaptation were found between the CHI group and the controls (F(1, 29) = 0.51, p = 0.48). This finding indicates that mild CHI does not impair implicit reflexive saccade adaptation and suggests that cerebellar function and functions of deeper brain structures such as the thalamus, superior colliculus and the basal ganglia may be largely preserved following mild CHI. The current results support the notion that the profile of oculomotor function after mild CHI reflects a centripetal gradient of impairment and relates closely to the functional integrity of the injured brain.

Automatic classification of athletes with residual functional deficits following concussion by means of EEG signal using support vector machine

There is a growing body of knowledge indicating long-lasting residual electroencephalography (EEG) abnormalities in concussed athletes that may persist up to 10-year postinjury. Most often, these abnormalities are initially overlooked using traditional concussion assessment tools. Accordingly, premature return to sport participation may lead to recurrent episodes of concussion, increasing the risk of recurrent concussions with more severe consequences. Sixty-one athletes at high risk for concussion (i.e., collegiate rugby and football players) were recruited and underwent EEG baseline assessment. Thirty of these athletes suffered from concussion and were retested at day 30 postinjury. A number of task-related EEG recordings were conducted. A novel classification algorithm, the support vector machine (SVM), was applied as a classifier to identify residual functional abnormalities in athletes suffering from concussion using a multichannel EEG data set. The total accuracy of the classifier using the 10 features was 77.1%. The classifier has a high sensitivity of 96.7% (linear SVM), 80.0% (nonlinear SVM), and a relatively lower but acceptable selectivity of 69.1% (linear SVM) and 75.0% (nonlinear SVM). The major findings of this report are as follows: 1) discriminative features were observed at theta, alpha, and beta frequency bands, 2) the minimal redundancy relevance method was identified as being superior to the univariate t -test method in selecting features for the model calculation, 3) the EEG features selected for the classification model are linked to temporal and occipital areas, and 4) postural parameters influence EEG data set and can be used as discriminative features for the classification model. Overall, this report provides sufficient evidence that 10 EEG features selected for final analysis and SVM may be potentially used in clinical practice for automatic classification of athletes with residual brain functional abnormalities following a concussion episode.

Persistent myalgia following whiplash

Persistent myalgia following whiplash is commonly considered the result of poor psychosocial status, illness behavior, or failing coping skills. However, there is much evidence that persistent myalgia may be due to neurophysiologic mechanisms involving peripheral and central sensitization. Myofascial trigger points may play a crucial role in maintaining sensitization. Recent research suggests that the chemical environment of myofascial trigger points is an important factor. Several consequences are reviewed when central pain mechanisms and myofascial trigger points are included in the differential diagnosis and in the management of patients with persistent pain following whiplash.

Chronic Post-Traumatic Neck and Head Pain

OBJECTIVE

This is a review of current concepts of chronic post-traumatic neck and head pain. In this article, I will emphasize the physiological and sociological aspects of these disorders.

BACKGROUND

The pathophysiology of chronic post-traumatic neck and head pain has not been well understood. Some have emphasized the organic factors and others the psychogenic aspects of these conditions. Only in recent years have this dichotomy been integrated with sociocultural concepts.

METHODS

The history of chronic post-traumatic head and neck pain is reviewed. Paradoxes are discussed, ie, the great differences in prevalence around the world, the inconsistent relationship of symptoms to degree of trauma, the curious phenomena of structural disease without symptoms, and symptoms without structural disease. The organic and pathophysiologic factors are reviewed, then those factors that modulate pain in these conditions are discussed.

CONCLUSION

Chronic post-traumatic neck and head pain is rarely either organic or psychogenic. Rather physiological, social, and cultural factors play major roles in modulating pain and either perpetuate or ameliorate these chronic pain conditions.

In vitro low-speed side collisions cause injury to the lower cervical spine but do not damage alar ligaments

Whether injuries to the alar ligaments could be responsible for complaints of patients having whiplash injury in the upper cervical spine is still controversially discussed. It is known that these ligaments protect the upper cervical spine against excessive lateral bending and axial rotation movements. The objective of the present in vitro study was therefore to examine whether the alar ligaments or any other structures of the cervical spine are damaged in side collisions. In a specially designed acceleration apparatus, six human osteoligamentous cervical spine specimens were subjected to incremental 90 degrees side collisions from the right (1 g, 2 g, 3 g, etc.) until structural failure occurred. A damped pivot table accounted for the passive movements of the trunk during collision, and a dummy head (4.5 kg) ensured almost physiological loading of the specimens. For quantification of functional injuries, the three-dimensional flexibility of the specimens was tested in a spine tester before and after each acceleration. In all six specimens, structural failure always occurred in the lower cervical spine and always affected the facet joint capsules and the intervertebral discs. In four specimens, this damage occurred during the 2 g collision, while in the other two it occurred during the 3 g and 4 g collision, respectively. The flexibility mainly increased in the lower cervical spine (especially in lateral bending to both sides) and, to a minor extent, in axial rotation. In vitro low-speed side collisions caused functional and structural injury to discoligamentous structures of the lower cervical spine, but did not damage the alar ligaments. Since the effects of muscle forces were not taken into account, the present in vitro study reflects a worst-case scenario. Injury thresholds should therefore not be transferred to reality.

Contemporary issues in mild traumatic brain injury11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated

OBJECTIVES

To determine (1) minimum criteria in adults for clinical diagnosis of mild traumatic brain injury (TBI) and (2) whether persistent postconcussive syndrome exists as a nosologic entity.

DATA SOURCES

PubMed search by MEDLINE of head injuries from January 1977 to July 2002.

STUDY SELECTION

All reviews and studies of mild TBI with special reference to those on persistent postconcussive syndrome having a general trauma cohort as a control comparison.

DATA EXTRACTION

Review of design and other methodologic issues. Studies dependent on superior strength of evidence (as defined by the American Academy of Neurology) concerning the biologic nature of persistent postconcussive syndrome.

DATA SYNTHESIS

A period of altered awareness with amnesia brought on by a direct craniofacial blow is the starting point in determining whether diffuse mild TBI has occurred. An amnestic scale is more helpful than Glasgow Coma Scale score in grading mild injury and in formulating minimum inclusion criteria for mild TBI. Neuropsychologic test results coupled with self-reported symptoms should not be taken as the primary source of evidence for mild TBI. Prolonged cognitive impairment after injury is not unique to brain trauma.

CONCLUSIONS

Persistent postconcussive syndrome after mild brain trauma, uncomplicated by focal injury, is biologically inseparable from other examples of the posttraumatic syndrome. To account for the persistent cognitive and behavioral sequelae of posttraumatic states, including persistent postconcussive syndrome, we need further studies on the emerging concept of limbic neuronal attrition occurring as a maladaptive response to pain and stress.

McLeod phenotype associated with a XK missense mutation without hematologic, neuromuscular, or cerebral involvement

BACKGROUND

The X-linked McLeod neuroacanthocytosis syndrome is a multisystem disorder with hematologic, neuromuscular, and central nervous system (CNS) manifestations. All carriers of the McLeod blood group phenotype examined so far had at least subclinical signs of systemic involvement.

STUDY DESIGN AND METHODS

Evaluation of two brothers carrying the McLeod phenotype with neurologic examination, immunohematology, RBC membrane protein Western blotting, analysis of XK DNA sequence and RNA levels, muscle histology including XK/Kell immunohistochemistry, cerebral magnetic resonance imaging (MRI), and quantified positron emission tomography (PET).

RESULTS

Immunohematology and Western blotting confirmed presence of the McLeod blood group phenotype. No acanthocytosis or other hematologic anomalies were found. XK gene sequence analysis revealed a missense mutation in exon 3 (E327K). WBC XK RNA levels were not decreased. There were no neuromuscular and CNS signs or symptoms. In addition, no subclinical involvement was discovered on the basis of normal muscle histology with a physiologic pattern of XK and Kell immunohistochemistry, normal cerebral MRI, and quantified PET.

CONCLUSION

Known disease-causing XK gene mutations comprised deletions, nonsense, or splice-site mutations predicting absent or truncated XK protein devoid of the Kell-protein binding site. Although the E327K missense mutation was associated with the immunohematologic characteristics of McLeod syndrome, the mutated XK protein seemed to be largely functional. These findings contribute to the understanding of the physiology of XK and Kell proteins, and the pathogenetic mechanisms of acanthocytosis, myopathy, and striatal neurodegeneration in McLeod syndrome.

A study of persistent post-concussion symptoms in mild head trauma using positron emission tomography

BACKGROUND

Complaints of persistent cognitive deficits following mild head trauma are often uncorroborated by structural brain imaging and neuropsychological examination.

OBJECTIVE

To investigate, using positron emission tomography (PET), the in vivo changes in regional cerebral uptake of 2-[(18)F]fluoro-2-deoxy-D-glucose (FDG) and regional cerebral blood flow (rCBF) in patients with persistent symptoms following mild head trauma.

METHODS

Five patients with mild head trauma and five age and education matched healthy controls were imaged using FDG-PET to measure differences in resting regional cerebral glucose metabolism. Oxygen-15 labelled water (H(2)(15)O)-PET was also used to measure group differences in rCBF changes during a spatial working memory task. In addition, neuropsychological testing and self report of dysexecutive function and post-concussion symptoms were acquired to characterise the sample.

RESULTS

There was no difference between patients and controls in normalised regional cerebral FDG uptake in the resting state in frontal and temporal regions selected a priori. However, during the spatial working memory task, patients had a smaller increase in rCBF than controls in the right prefrontal cortex.

CONCLUSIONS

Persistent post-concussive symptoms may not be associated with resting state hypometabolism. A cognitive challenge may be necessary to detect cerebral changes associated with mild head trauma.

Late whiplash syndrome: correlation of brain SPECT with neuropsychological tests and P300 event-related potential

BACKGROUND

The acceleration forces infringing the cervical spine in whiplash injury are frequently associated with multiple cerebral symptoms. The purpose of this study was to determine whether there is a correlation between cerebral perfusion findings, P300 recording (an electrophysiologic marker of cognitive ability), and neuropsychological tests in patients with whiplash injury.

METHODS

Twenty patients with chronic whiplash injury underwent extensive clinical evaluation and neuropsychological testing. A brain single-photon emission computed tomography (SPECT) study using 99mTc-HMPAO was performed in all patients within 24 hours of neuropsychological evaluation. P300 event-related potentials were performed in 15 patients and in 9 normal volunteers.

RESULTS

Thirteen of 20 patients had brain perfusion abnormalities on the SPECT studies, in one or more regions. Eight of 15 patients had abnormal P300 studies. Seven of eight patients with abnormal P300 had also an abnormal SPECT study. Seven of 15 patients had normal P300 results, 6 of them with a normal SPECT and 1 with SPECT abnormalities. There was no significant correlation between the SPECT findings or the P300 results and the scores of attention and working memory. There was, however, close agreement between the SPECT and P300.

CONCLUSION

SPECT perfusion abnormalities in patients with chronic whiplash syndrome correlate well with P300 recording. The combination of these studies with neurocognitive and neurobehavioral tests may be useful in identifying a subgroup of patients having organic brain lesions.

fMRI response during visual motion stimulation in patients with late whiplash syndrome

After whiplash trauma, up to one fourth of patients develop chronic symptoms including head and neck pain and cognitive disturbances. Resting perfusion single-photon-emission computed tomography (SPECT) found decreased temporoparietooccipital tracer uptake among these long-term symptomatic patients with late whiplash syndrome. As MT/MST (V5/V5a) are located in that area, this study addressed the question whether these patients show impairments in visual motion perception. We examined five symptomatic patients with late whiplash syndrome, five asymptomatic patients after whiplash trauma, and a control group of seven volunteers without the history of trauma. Tests for visual motion perception and functional magnetic resonance imaging (fMRI) measurements during visual motion stimulation were performed. Symptomatic patients showed a significant reduction in their ability to perceive coherent visual motion compared with controls, whereas the asymptomatic patients did not show this effect. fMRI activation was similar during random dot motion in all three groups, but was significantly decreased during coherent dot motion in the symptomatic patients compared with the other two groups. Reduced psychophysical motion performance and reduced fMRI responses in symptomatic patients with late whiplash syndrome both point to a functional impairment in cortical areas sensitive to coherent motion. Larger studies are needed to confirm these clinical and functional imaging results to provide a possible additional diagnostic criterion for the evaluation of patients with late whiplash syndrome.

Perfusion brain SPECT and statistical parametric mapping analysis indicate that apathy is a cingulate syndrome: a study in Alzheimer's disease and nondemented patients

Apathy is the most frequent behavioral symptom in Alzheimer's disease and is also frequently reported in other brain organic disorders occurring in the elderly. Based on the literature, we hypothesized that apathy was related to an anterior cingulate hypofunction. Forty-one subjects were studied. According to ICD 10 diagnostic criteria, 28 patients had Alzheimer dementia (demented: diagnostic group 1), and 13 had organic personality disorders or mild cognitive impairment not attributable to dementia (nondemented: diagnostic group 2). Apathy was evaluated by the Neuro-Psychiatric Inventory. As a result each diagnostic group was divided into two symptomatic subgroups: apathetic or nonapathetic. Brain perfusion was measured by (99m)Tc-labeled bicisate (ECD) brain SPECT and the images were compared using Statistical Parametric Mapping (SPM96). We began by comparing apathetic vs nonapathetic patients, whatever their diagnostic group (whole population), then analyzed them within each group. Twenty-one subjects were apathetic (14 in group 1 and 7 in group 2) and 20 were not (14 in group 1 and 6 in group 2). For the whole population, the Z map showed a significant decrease in ECD uptake for the apathetic patients in the anterior cingulate (P < 0.002) bilaterally. This area was also identified as hypoactive by SPM analysis in the demented (P < 0.035) and in the nondemented (P < 0.02) apathetic patient groups. Finally, conjunction analysis indicated that the anterior cingulate was the common hypoactive structure of the two apathetic subgroups (Z = 4.35, P < 0.0009). These results point to a close relationship between apathy and the anterior cingulate region.

Applying the Quebec Task Force criteria as a frame of reference for studies of whiplash injuries

Research prior to 1995 showed a diversity of either inclusion or exclusion criteria (or both) for diagnosing whiplash injury. As a consequence, the Quebec Task Force (QTF) developed expert-based criteria, which may be considered as a the 'new' gold standard. Here, we examined the inclusion criteria and exclusion criteria used in research populations from the major 82 research studies performed during the period 1980-1998, comparing their similarities and dissimilarities to the QTF standard. None of the articles satisfied the QTF definitions completely, either before or after their introduction in 1995. Nevertheless, the QTF still seems to have had some impact on either the published inclusion or exclusion criteria. We observed that both sets of criteria showed a qualitative shift following the QTF publication in 1995. For the inclusion criteria, we found both a statistically significant increase in use of the QTF definition (acceleration-deceleration mechanism, rear-end collision, motor vehicle collision or other mishaps) and in the criterion 'neck pain'. We also observed some smaller changes in both inclusion and exclusion criteria but none of these was significant statistically.

The enigma of whiplash injury. Current management strategies and controversies

How to diagnose and treat whiplash injuries, particularly in chronic cases, is one of the most controversial topics in medicine. Current diagnostic approaches cannot fully define the pathophysiologic mechanisms of these injuries, and traditional treatment regimens often fail to completely relieve symptoms. Dr Young reviews current management strategies and controversies and discusses potential methods of dealing with chronic cases.

The postconcussion syndrome after mild head trauma: is brain damage overdiagnosed? Part 1

Many investigators attribute the postconcussion syndrome following mild closed head injury to permanent brain damage. The evidence supporting this conclusion is reviewed, including the force necessary to cause permanent brain damage; the basis for determining whether the patient was exposed to sufficient force in the accident to permanently damage the brain; the basis for determining whether the patient actually has permanent brain damage (not just brain dysfunction) traceable to the accident; and whether the location and severity of brain damage is sufficient to account for the postconcussion syndrome.

CONCLUSION

the evidence for permanent traumatic brain damage as the cause of the postconcussion syndrome following mild closed head injury is weak.

Whiplash associated disorders: is there a place for psychiatrists and psychologists?

Between 25 and 30% of the victims of a whiplash injury have complaints after one year. This condition is referred to as late whiplash syndrome. This syndrome is characterized by pain of the neck, headache, forgetfulness, poor concentration, mental fatigue, and affective symptoms. The causes of the persistent symptoms are unknown. In all, the evidence that late-whiplash syndrome is a neurological disorder is flimsy. Current opinion holds that the acute basis is the painful injury of the neck. In the months following the accident, pain is the substrate on which psychological and social factors may act. Emotional symptoms such as lability of affect and disturbed mood, or posttraumatic stress disorders are common after whiplash. Although there is definitely a place for psychiatrists and psychologists in the treatment of late whiplash syndrome, these professionals are not involved in late whiplash disorder as much as they should be. Brief psychological treatment has proven to significantly reduce the severity and duration of symptoms. Optimal management must cover the treatment of pain, depression, anxiety, and fatigue; adequate psycho-education, stressing the good long-term outcome; and education of patients and relatives on possible cognitive symptoms.

Functional neuroimaging correlates of functional amnesia

Especially in the field of memory encoding and retrieval, the results of functional neuroimaging have provided new insights in anatomico-functional interactions. In particular this holds true for the role of the prefrontal cortex in mnestic information processing, for the contribution and participation of the two hemispheres in various processes of information transmission, and for views on disturbed information processing after organically obvious and so-called psychogenic forms of memory impairments. This report particularly stresses the insights obtained by functional neuroimaging for probably environmentally triggered deficiencies in memory processing and discusses possible subtle neuroanatomical correlates of functional amnesias. It is especially emphasised that stress conditions and depressive states may modify the release of steroids (glucocorticoids) and transmitter agonists at the brain level with the consequence of selective memory disturbances which may manifest as a "mnestic block syndrome".

Relation between neuropsychological and neuroimaging findings in patients with late whiplash syndrome

OBJECTIVES

The interpretation of long term cognitive impairment after whiplash injury is still a problem for many physicians. On the grounds of nuclear medicine findings previous research speculated that brain damage is responsible for cognitive problems of patients with whiplash. To test this hypothesis the relation between neuroimaging and neuropsychological findings was analysed.

METHODS

Twenty one patients (11 women, 10 men, mean age 42.2 (SD 8.6) years) with the late whiplash syndrome (average interval of trauma 26.1 (SD 20.7) months) referred for diagnostic action to the Department of Neurology were investigated. Assessment included computer assisted assessment of working memory and divided attention, neuroimaging (by the means of [99mTc]-HMPAO-SPECT, [15O]-H2O-PET and [18F]-FDG-PET), testing of emotional functioning (depression and anxiety ratings), and pain intensity at the time of testing.

RESULTS

On average, scoring on tests of cognitive functioning was very low. However, no significant correlations were found between regional perfusion or metabolism in any brain area and the scores of divided attention or working memory. By contrast, significant relations were found between indices of impaired emotional functioning (state anxiety) and divided attention. In addition, low scoring in divided attention was significantly correlated with pain intensity at the time of testing.

CONCLUSIONS

The present data do not provide evidence of a significant relation between detectable morphological or functional brain damage and impaired cognitive performance in the late whiplash syndrome. Results indicate triggering of emotional and cognitive symptoms on the basis of initial injury of the cervical spine.