21/66. Transient short free running circadian rhythm in a case of aneurysm near the suprachiasmatic nuclei.A free running circadian rest-activity cycle is rare in sighted individuals living in a normal environment. Even more rare is a periodicity shorter than 24 hours, as observed in actigraphic recordings in a female patient during convalescence after a whiplash injury in a car accident. The documented free running period was 22.5 hours for 19 days. During the subsequent weeks re-entrainment occurred following re-establishment by a social zeitgeber, with a slightly early circadian phase of nocturnal melatonin onset relative to a late sleep period. magnetic resonance imaging and cerebral angiography showed an aneurysm at the bifurcation of the right internal carotid artery, close to the circadian pacemaker structure (the suprachiasmatic nuclei), which was later occluded.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
22/66. Traumatic retropharyngeal hematoma and prevertebral edema induced by whiplash injury.Whiplash injury commonly results in cervical spine trauma. We report a case of a 58-year-old man, who sustained a whiplash injury from contact with the headrest of his seat after his car was involved in a rear-end collision. He presented with sore throat, hoarseness, difficulty in swallowing and progressing dyspnea. The diagnostic work-up comprising lateral radiograph, CT and MR imaging disclosed the rare constellation of a retropharyngeal hematoma and prevertebral edema without further injury of the cervical spine structures. Compression of the upper airways was evident. A careful history and an appropriate diagnostic approach are essential for the work-up and management of such a life-threatening situation.- - - - - - - - - - ranking = 7keywords = injury (Clic here for more details about this article) |
23/66. Assessment of the "nearly normal" cervical spine radiograph: C2-C3 pseudosubluxation in an adult with whiplash injury.C2-C3 pseudosubluxation is a well recognized normal anatomical variant in children and this physiological spondylolisthesis often makes the interpretation of paediatric cervical spine radiographs difficult. In direct contrast, this finding is rare in adults and has not been reported as a diagnostic difficulty following neck injury. We report a case of C2-C3 pseudosubluxation occurring in a 27 year old woman presenting with neck pain 1 week after a road traffic accident. Although there are effective radiological guidelines for cervical spine radiograph evaluation in children, there is no evidence that these can be applied to the adult cervical spine. Flexion and extension cervical spine views have limitations. In such cases, magnetic resonance imaging is required to definitively exclude pathological injury.- - - - - - - - - - ranking = 6keywords = injury (Clic here for more details about this article) |
24/66. Cervical vertigo and dizziness after whiplash injury.Whiplash injury is not only limited to neck injury but also brainstem injury that does not involve direct damage to the neck or head. The symptoms of whiplash injury are polymorphous, with the most common complaints being cervical pain, headache and scapulodynia. vertigo and dizziness are also reported in 25-50% of the cases. In otoneurologic studies, magnetic resonance angiography (MRA) is used for the evaluation of vertebrobasilar hemodynamics in patients who complain of dizziness and vertigo. It is reported that vertebrobasilar artery insufficiency (VBI) leads to brainstem and cerebellar ischemia and infarction following cervical manipulation. Here we examined the correlation between vertigo or dizziness and the right and left side difference in vertebral arteries after whiplash injury using MRA. We studied 20 patients who complained of neck pain with vertigo or dizziness after whiplash injury and 13 healthy volunteers as a control. In the control group, abnormal MRA findings in the vertebral arteries such as occlusion, stenosis or slow blood flow were seen in 77% of the cases. In the patient group, abnormal MRA findings were seen in 60%. The side difference in blood flow was 3.5 /-2.5 cm/s in the control group and 6.1 /-3.0 cm/s in the patient group. Our findings suggest that some subjects with persistent vertigo or dizziness after whiplash injury are more likely to have VBI on MRA. VBI might be an important background factor to evoke cervical vertigo or dizziness after whiplash injury. The side difference between the two vertebral arteries could cause a circulation disorder in the vertebrobasilar system after whiplash injury. However, the VBI on MRA itself was also seen in the control group, and thus it is not clear whether it is due to whiplash injury in the patient group.- - - - - - - - - - ranking = 14keywords = injury (Clic here for more details about this article) |
25/66. Internal carotid artery stenosis due to atherosclerotic plaque damage after whiplash injury.Blunt traumatic occlusion or stenosis of the internal carotid artery is a rare complication of whiplash injury and may not be recognized until the onset of neurological symptoms. The clinical course can vary considerably, with regard to both the symptoms and the interval between injury and manifestation. A dissecting aneurysm and intimal tear are usually observed after blunt internal carotid artery injury. Atherosclerotic plaque is often observed in the cervical internal carotid artery and carotid bifurcation, but involvement of plaque has been confirmed in relatively few cases of blunt traumatic internal carotid injury. We describe a 58-year-old man who developed cerebral embolism due to intraplaque thrombus after a minor whiplash injury and was successfully treated with carotid endarterectomy. Because thrombosis occurred within the atherosclerotic plaque, we named the mechanism of this case "plaque injury".- - - - - - - - - - ranking = 10keywords = injury (Clic here for more details about this article) |
26/66. Traumatic clivus epidural hematoma: case report and review of the literature.BACKGROUND: Traumatic clival epidural hematoma is an extremely rare reported entity. CASE DESCRIPTION: We describe the case of a 26-year-old woman involved in a car accident who presented with a glasgow coma scale score of 13, bilateral abducens palsy, bilateral numbness on the mandibular territory of the trigeminal nerve, and left hypoglossal palsy. Radiological examinations revealed a clival epidural hematoma. The patient was managed conservatively, with clinical improvement of her neurological condition. This is the first traumatic clival epidural hematoma reported in an adult. From a review of the literature, we found only 8 cases. CONCLUSION: The pathophysiology of these hematomas is still a subject of debate; occipitoatlantoaxial ligamentous instability may play a role in it. In one third of the cases, bilateral cranial nerve palsies were associated. Apparently, they have a benign outcome.- - - - - - - - - - ranking = 0.0068371771718967keywords = nerve (Clic here for more details about this article) |
27/66. retropharyngeal abscess, airway obstruction, and tetraplegia after hyperextension injury of the cervical spine: case report.A retropharyngeal abscess resulted from perforation of the posterior pharyngeal wall by an anterior marginal osteophyte at the time of hyperextension injury of the cervical spine. The abscess communicated with the epidural space via the disrupted intervertebral disk, leading to the delayed onset of upper airway obstruction and tetraparesis.- - - - - - - - - - ranking = 5keywords = injury (Clic here for more details about this article) |
28/66. Post-traumatic migraine: chronic migraine precipitated by minor head or neck trauma.Minor trauma to the head or neck is occasionally followed by severe chronic headaches. We have evaluated 35 adults (27 women, 8 men) with no prior history of headaches, who developed recurrent episodic attacks typical of common or classic migraine following minor head or neck injuries ("post-traumatic migraine"-PTM). The median age of these patients was 38 years (range 17 to 63 years), which is older than the usual age at onset of idiopathic migraine. The trauma was relatively minor: 14 patients experienced head trauma with brief loss of consciousness, 14 patients sustained head trauma without loss of consciousness, and 7 patients had a "whiplash" neck injury with no documented head trauma. Headaches began immediately or within the first few days after the injury. PTM typically recurred several times per week and was often incapacitating. The patients had been unsuccessfully treated by other physicians, and there was a median delay of 4 months (range 1 to 30 months) before the diagnosis of PTM was suspected. The response to prophylactic anti-migraine medication (propranolol or amitriptyline used alone or in combination) was gratifying, with 21 of 30 adequately treated patients (70%) reporting dramatic reduction in the frequency and severity of their headaches. Improvement was noted in 18 of the 23 patients (78%) who were still involved in litigation at the time of treatment. The neurologic literature has placed excessive emphasis on compensation neurosis and psychological factors in the etiology of chronic headaches after minor trauma. physicians must be aware of PTM, as it is both common and treatable.- - - - - - - - - - ranking = 2keywords = injury (Clic here for more details about this article) |
29/66. Post whiplash dystonia well controlled by transcutaneous electrical nervous stimulation (TENS): case report.It has been established that peripheral trauma can cause focal and generalized dystonias, which may be difficult to treat. The case presented of a 28-year-old with post whiplash focal dystonia shows that transcutaneous electrical nerve stimulation (TENS) may be a useful treatment in the early management of focal dystonias which fail to respond to conventional therapy.- - - - - - - - - - ranking = 0.0034185885859483keywords = nerve (Clic here for more details about this article) |
30/66. Traumatic aneurysm of the extracranial internal carotid artery due to hyperextension of the neck.Aneurysms of the extracranial internal carotid artery (ICA) are rare. The majority arise iatrogenically after surgery, but a few follow trauma. Traumatic aneurysms of the ICA may follow penetrating injury, direct "blunt trauma" injury or hyperextension of the neck. We report a case of traumatic ICA aneurysm which probably followed a hyperextension injury to the cervical spine in a young woman.- - - - - - - - - - ranking = 3keywords = injury (Clic here for more details about this article) |
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