title: Role of spinal inhibitory mechanisms in whiplash injuries.
abstract: Whiplash injury, commonly encountered in road traffic accidents, is a major cause of morbidity. Its pathophysiology is not well understood, and diagnosis remains clinical. Imaging and electrophysiological methods have not provided objective diagnostic evidence. Availability of a sensitive and specific diagnostic method would be of high clinical interest. We studied 20 consecutive patients with chronic whiplash injury. Despite persistent symptoms, most had minimal neurological findings. Cutaneous silent period (CSP), a nociceptive spinal inhibitory electromyographic reflex, showed 90% sensitivity and 90% specificity for its diagnosis. In contrast, only two patients (10%) had abnormal transcranial magnetic stimulation findings, and another two (10%) showed abnormal electromyography. Magnetic resonance imaging (MRI) showed cervical cord abnormalities in only two of 20 (10%) patients. None of the patients had abnormal somatosensory evoked potential studies. Our findings suggest that neurological dysfunction of whiplash may occur at several possible spinal cord localities in the CSP functional pathway. The use of this simple, quick, and sensitive method is advocated in the diagnostic work up of whiplash injury.
authors.affiliation: Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore. lo.yew.long@sgh.com.sg
authors.forename: Yew-Long
authors.initials: YL
authors.lastname: Lo
authors.forename: Yam-Eng
authors.initials: YE
authors.lastname: Tan
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fook-Chong
authors.forename: Pensie
authors.initials: P
authors.lastname: Boolsambatra
authors.forename: Wai-Mun
authors.initials: WM
authors.lastname: Yue
authors.forename: Ling-Ling
authors.initials: LL
authors.lastname: Chan
authors.forename: Seang-Beng
authors.initials: SB
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D004568:Electrodiagnosis / Q000379:methods*; D004576:Electromyography / Q000379:methods; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology; D009433:Neural Inhibition / Q000502:physiology*; D009434:Neural Pathways / Q000473:pathology / Q000503:physiopathology; D009619:Nociceptors / Q000502:physiology; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012016:Reference Values; D012021:Reflex, Abnormal / Q000502:physiology; D012680:Sensitivity and Specificity; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology*; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D050781:Transcranial Magnetic Stimulation / Q000379:methods; D014911:Whiplash Injuries / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*