Jang Sung Ho, Kwon Young Hyeon
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea.
Front Neurol. 2018 Feb 8;9:57. doi: 10.3389/fneur.2018.00057. eCollection 2018.
Whiplash is a bony or soft tissue injury resulting from an acceleration-deceleration energy transfer in the neck. Although patients with whiplash injury often complain of cerebral symptoms, and previous studies have reported evidence indicating brain injury, such an association has not been clearly elucidated. Traumatic axonal injury (TAI) is tearing of axons due to indirect shearing forces during acceleration, deceleration, and rotation of the brain or to direct head trauma. Diffusion tensor imaging (DTI) has a unique advantage to detect TAI in patients whose conventional brain CT or magnetic resonance imaging (MRI) results were negative following head trauma. Since the introduction of DTI, six studies using diffusion tensor tractography (DTT) based on DTI data have reported TAI in patients with whiplash injury, even though conventional brain CT or MRI results were negative. A precise TAI diagnosis in whiplash patients is clinically important for proper management and prognosis. Among the methods employed to diagnose TAI in the six previous studies, the common diagnostic approach for neural tract TAI in individual patients with whiplash injury were (1) whiplash injury history due to car accident; (2) development of new clinical symptoms and signs after whiplash injury; (3) evidence of neural tract TAI in DTT results, mainly configurational analysis; and (4) coincidence of newly developed clinical manifestations and the function of injured neural tracts. All six studies were individual patient case studies; therefore, further prospective studies involving larger number of subjects should be encouraged.
挥鞭样损伤是颈部因加速-减速能量传递导致的骨骼或软组织损伤。尽管挥鞭样损伤患者常主诉脑部症状，且既往研究已报道有证据表明存在脑损伤，但这种关联尚未得到明确阐释。创伤性轴索损伤（TAI）是指在脑加速、减速和旋转过程中因间接剪切力或头部直接外伤导致的轴突撕裂。弥散张量成像（DTI）在检测头部外伤后常规脑CT或磁共振成像（MRI）结果为阴性的患者的TAI方面具有独特优势。自DTI问世以来，六项基于DTI数据使用弥散张量纤维束成像（DTT）的研究报告了挥鞭样损伤患者存在TAI，尽管常规脑CT或MRI结果为阴性。对挥鞭样损伤患者进行精确的TAI诊断对于正确的管理和预后具有重要临床意义。在之前六项研究中用于诊断TAI的方法中，对个体挥鞭样损伤患者神经束TAI的常见诊断方法为：（1）有因车祸导致的挥鞭样损伤病史；（2）挥鞭样损伤后出现新的临床症状和体征；（3）DTT结果中有神经束TAI的证据，主要是构型分析；（4）新出现的临床表现与受损神经束功能相符。所有六项研究均为个体患者病例研究；因此，应鼓励开展涉及更多受试者的进一步前瞻性研究。
