title: Altered Regional Cerebral Blood Flow in Chronic Whiplash Associated Disorders.
abstract: 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 H2(15)O 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.
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Huispostcode EB50, Postbus 30001, 9700 RB Groningen, The Netherlands. Electronic address: d.vallez-garcia@umcg.nl.
authors.forename: David
authors.initials: D
authors.lastname: Vállez García
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Huispostcode EB50, Postbus 30001, 9700 RB Groningen, The Netherlands. Electronic address: j.doorduin@umcg.nl.
authors.forename: Janine
authors.initials: J
authors.lastname: Doorduin
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Huispostcode EB50, Postbus 30001, 9700 RB Groningen, The Netherlands. Electronic address: a.t.m.willemsen@umcg.nl.
authors.forename: Antoon T M
authors.initials: AT
authors.lastname: Willemsen
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Huispostcode EB50, Postbus 30001, 9700 RB Groningen, The Netherlands. Electronic address: r.a.dierckx@umcg.nl.
authors.forename: Rudi A J O
authors.initials: RA
authors.lastname: Dierckx
authors.affiliation: Division of Biomedical Engineering, Department of Electrical Engineering and Information Technology, Offenburg University, D-77652 Offenburg, Germany. Electronic address: andreas.otte@hs-offenburg.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Otte
mesh_terms: D000328:Adult; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology; D016022:Case-Control Studies; D002560:Cerebrovascular Circulation; D002908:Chronic Disease; D006801:Humans; D059906:Neuroimaging; D049268:Positron-Emission Tomography; D014911:Whiplash Injuries / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D055815:Young Adult
keywords: Neuropsychological questionnaires; Non-painful electrical stimulation; Positron emission tomography; Whiplash associated disorders