Intracranial hypotension following motor vehicle accident: an overlooked cause of post-traumatic head and neck pain?
Motor vehicle accidents result in many patients with chronic head and neck pain, some of which meet the criteria for a "whiplash syndrome." The cervical zygapophysial joint synovium, muscular, and ligamentous strains and other anatomical sites are often implicated in the pathophysiology of these cases. Some patients have a characteristic constellation of vague neurological symptoms, often including headache, posterior neck discomfort, dizziness, nausea, and sometimes visual changes. Recently presented research has noted that some patients who have a whiplash-associated disorder have imaging findings consistent with a low-pressure cerebrospinal fluid leak. Some of these patients respond favorably to high-volume epidural blood patch. The following case presentation focuses on the differential diagnosis of a post-traumatic headache syndrome, specific imaging findings, and treatment strategies.
Huntoon
Marc A
MA
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. huntoon.marc@mayo.edu
Watson
James C
JC
D000063:Accidents, Traffic; D000700:Analgesics / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use*; D017217:Blood Patch, Epidural; D004172:Diplopia / Q000209:etiology; D004359:Drug Therapy, Combination; D005260:Female; D006261:Headache / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D019585:Intracranial Hypotension / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology; D009853:Omeprazole / Q000627:therapeutic use
D000700:Analgesics; D009853:Omeprazole; D001241:Aspirin; D007052:Ibuprofen