Whiplash, Brain Injury, Concussion, Auto Injury

The biggest challenge with treating auto injuries is getting a proper diagnosis. Countless studies show that whiplash patients have objective, organic injuries; unfortunately, many of these injuries are difficult to pinpoint with conventional diagnostic imaging techniques, such as CT or MRI.

Further complicating diagnosis is the fact that the focal point of the injury in most patients is the neck. Due to the complexity of the cervical spine, many different structures can be injured and the symptoms of different types of injuries can overlap with other kinds of injuries.

A current study looks at this problem; specifically, it examines the diagnostic challenge of differentiating whiplash associated disorder (WAD) from concussion in patients with neck injuries.

For many years, researchers have realized that many patients with whiplash present with symptoms similar to patients with brain injury. The chart shows the most common symptoms of brain injury. Over the last ten years, dozens of studies have been published showing that many whiplash patients complain of the same problems. The challenge is to determine which patients have TBI and which have spinal injuries.

The authors decided to study the issue by looking at hockey players. They followed 20 teams (183 players) for a single season. During that time, 13 players received either a whiplash injury or a concussion. Each of the injured players was given a thorough examination. This is what the study found:

• All of the patients with whiplash injury (6 players) reported concussion symptoms, even if the patient had the least severe type of whiplash injury.
• “Full resolution of concussion symptoms at the 7-10 day follow-up evaluation was reported by five of the 13 subjects. Of these five subjects, two were still experiencing WAD symptoms.”
• 12 of the 13 injured players reported headache; 10 of the 13 reported dizziness.

At the 7-10 day follow-up:

• 6 of the 13 injured players reported a complete resolution of whiplash symptoms, but three of the six were still experiencing the symptoms of concussion.
• “Full resolution of concussion symptoms at the 7–10 day follow-up evaluation was reported by five of the 13 subjects. Of these five subjects, two were still experiencing WAD symptoms.”
• “Overall, only three of the 13 subjects or 23% experienced full resolution of both their WAD and concussion symptoms at the follow-up evaluation.”

The authors have this to say about their findings:

“The athletes studied in this investigation experienced symptoms of both WAD and concussion after a head and/or neck complex acceleration/deceleration injury. However, the number of concussion symptoms they experienced did not associate with an increased severity of WAD grading. Symptom resolution during the 7–10 day follow-up period differed between athletes and injury mechanisms. Based on the observed prevalence of symptoms of both WAD and concussion irrespective of the mechanism of injury, it is important for the clinician treating a patient or athlete for WAD to evaluate for symptoms of concussion and for the team therapist/clinician to be cognizant of conducting a thorough cervical evaluation when dealing with concussed players.”

The same holds true for non-athlete patients in motor vehicle collisions. Because symptoms of traumatic brain injury can overlap with those of cervical spine injury, patients with symptoms of brain injury should be carefully examined for the presence of concussion.

Of particular concern are those patients who don’t seem to be recovering from the current treatment, or for those patients who experience personality changes after the collision. Undiagnosed brain injury can result in unemployment, divorce, depression, and other serious social and medical problems.

Hynes LM, Dickey JP. Is there a relationship between whiplash-associated disorders and concussion in hockey? Brain Injury 2006;20(2):179-188.