Whiplash

Whiplash is a neck injury commonly resulting from a sudden acceleration-deceleration force, such as in a car accident. It can lead to a variety of symptoms and requires appropriate management. Here are some key points regarding whiplash:

Symptoms

• Neck Pain and Stiffness: The most common symptoms, often accompanied by reduced range of motion.
• Headaches: Typically starting at the base of the skull.
• Shoulder and Back Pain: Pain may radiate to the shoulders and upper back.
• Dizziness and Fatigue: Some individuals experience dizziness and general fatigue.
• Tingling or Numbness: In the arms or hands, indicating nerve involvement.
• Cognitive Symptoms: Such as difficulty concentrating or memory issues.

Treatment

• Rest: Short-term rest can be beneficial, but prolonged inactivity should be avoided.
• Ice and Heat Therapy: Applying ice for the first 24 hours followed by heat can help reduce pain and swelling.
• Pain Management: Over-the-counter pain relievers like NSAIDs can help manage pain and inflammation.
• Physical Therapy: Gentle exercises and physical therapy can aid in restoring movement and strength.
• Neck Collar: A cervical collar may be used for short-term support, but prolonged use is not recommended.
• Alternative Therapies: Techniques such as massage, acupuncture, or chiropractic care may provide relief for some individuals.

Ocular manifestations of whiplash, often associated with Whiplash Associated Disorders (WAD), can include a variety of symptoms related to eye movement and visual disturbances. Some of the common ocular manifestations include:

1. Altered Eye Movements: Patients with whiplash may experience changes in compensatory eye movements and smooth pursuit movements, which can impair the coordination of head and eyes.

2. Nystagmus: This involuntary eye movement can occur as a result of vestibulo-ocular reflex disturbances.

3. Visual Disturbances: Symptoms such as blurred vision, double vision (diplopia), and decreased stereoacuity can be present.

4. Convergence and Accommodation Issues: Some patients may have difficulty with eye convergence and accommodation, leading to visual discomfort and strain.

5. Superior Oblique Muscle Paresis: This can result in vertical diplopia and difficulty with eye movements.

6. Dizziness and Unsteadiness: These symptoms are often related to visual disturbances and can be exacerbated by head movements.

These manifestations are thought to be related to the impact of whiplash on the cervical spine and its influence on the oculomotor and vestibular systems. A thorough clinical evaluation is necessary to assess these symptoms and guide appropriate management.

Whiplash can potentially affect cranial nerves, although this is less common compared to its effects on the cervical spine and peripheral nerves. Here are some ways in which whiplash might impact cranial nerves:

1. Trigeminal Nerve (CN V): There have been reports of traumatic trigeminal neuropathy following whiplash injuries, which can lead to facial pain or sensory disturbances.

2. Spinal Accessory Nerve (CN XI): This nerve can be affected, leading to pain and impaired ability to raise the shoulder, as it innervates the sternocleidomastoid and trapezius muscles.

3. Neck-Tongue Syndrome: This condition involves numbness of the tongue and is thought to be caused by compression of the second cervical root, which receives afferent fibers from the lingual nerve.

4. Lower Cranial Nerve Palsy: In rare cases, bilateral lower cranial nerve paralysis may occur due to a whiplash mechanism, even without fractures of the skull base or primary brain stem injury.

While these occurrences are not typical, they highlight the potential for whiplash to affect cranial nerves under certain circumstances. If cranial nerve involvement is suspected, further evaluation by a neurologist may be warranted.

Prognosis

Most people recover from whiplash within a few weeks to months, but some may experience chronic symptoms. Early intervention and a tailored treatment plan can improve outcomes and reduce the risk of long-term complications. If symptoms persist or worsen, further evaluation by a Neurologist/Neurosurgeon is advised.

please watch video by eminent Neurosurgeon, Dr. Betsy Grunch: https://www.youtube.com/watch?v=d_Gf_DXPG2s&t=7s

Author

Paddy Kalish OD, JD and B.Arch