Epidural blood patch therapy for chronic whiplash-associated disorder.
BACKGROUND
Despite the absence of objective neurological deficits, patients with chronic whiplash-associated disorder (WAD) complain of symptoms such as headache, dizziness, and nausea. These symptoms are also often experienced by patients with cerebrospinal fluid (CSF) leak. It was recently reported that radioisotope (RI) cisternography is useful in the diagnosis of intracranial hypotension due to CSF leak. We investigated the relation between chronic WAD and CSF leak by RI cisternography and evaluated whether epidural blood patch (EBP) administration is effective in the treatment of chronic WAD.


METHODS
We studied 66 patients with chronic WAD with symptoms lasting longer than 3 mo. All patients underwent RI cisternography to determine the presence of CSF leak. In patients in whom CSF leak was identified, EBP was administered. Symptoms were assessed before, 1 wk after, and 6 mo after EBP. Work status was also assessed and follow-up RI cisternography was performed.


RESULTS
Of the 66 patients, 37 showed CSF leak, and 36 of these patients received EBP 2.2 +/- 0.7 times. The mean duration of symptoms was 33 mo. One week after EBP, the percentage of patients with symptoms was decreased significantly compared with that before EBP; headache: 100% vs 17%, respectively, memory loss: 94% vs 28%, dizziness: 83% vs 47%, visual impairment: 81% vs 25%, nausea: 78% vs 42% (P < 0.01). These effects were also observed at the 6 month follow-up examination (P < 0.01). Work status was also significantly improved at follow-up.


CONCLUSIONS
We conclude that CSF leak should be considered in some cases of chronic WAD and that EBP is an effective therapy for chronic WAD.
Ishikawa
Shinichi
S
Department of Anesthesiology, Fukuyama Kohnan Hospital, Kohnan-cho, Fukuyama City, Hiroshima, Japan.
Yokoyama
Masataka
M
Mizobuchi
Satoshi
S
Hashimoto
Hidenori
H
Moriyama
Eiji
E
Morita
Kiyoshi
K
D000328:Adult; D017217:Blood Patch, Epidural; D002908:Chronic Disease; D002946:Cisterna Magna / Q000000981:diagnostic imaging; D004824:Epidural Space / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007205:Indium Radioisotopes; D019585:Intracranial Hypotension / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D004369:Pentetic Acid / Q000031:analogs & derivatives; D011877:Radionuclide Imaging; D013997:Time Factors; D016896:Treatment Outcome; D014911:Whiplash Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy
D007205:Indium Radioisotopes; D004369:Pentetic Acid