Jang Sung Ho, Kwon Young Hyeon, Lee Sung Jun
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University 317-1, Daemyungdong, Namku, Daegu 705-717, Korea.
Diagnostics (Basel). 2019 Oct 8;9(4):145. doi: 10.3390/diagnostics9040145.
We report on a patient with whiplash injury who had central pain, due to injury of the spinothalamic tract (STT), but who was misdiagnosed as complex regional pain syndrome (CRPS).
While a minivan in which a 43-year-old female was seated in the passenger seat was stopped for a signal, a truck collided with the minivan from behind, and the minivan then repeatedly collided with trucks in front and behind the minivan. Her head repeatedly struck the minivan seat resulting in whiplash injuries. After onset, she felt pain in both legs with mild motor weakness in all four extremities and memory impairment. Eight years after onset, she was diagnosed at a university hospital as CRPS type 1 with the clinical features of hyperalgesia and mild edema and motor weakness of both legs. She visited another university hospital nine years after onset and complained of pain in the right arm and both legs, constant tingling and burning pain along with allodynia and hyperalgesia. She also showed mild weakness in the four extremities, mild edema of both legs, and memory impairment. On diffusion tensor tractography (DTT), the left spinothalamic tract (STT) showed marked narrowing, and the right STT revealed mild narrowing and partial tearing. In addition, partial tears were observed in both corticospinal tracts and the right corticoreticulospinal tract. Discontinuations were observed in the left corticoreticulospinal tract and the left fornical crus.
Injury of the STT was demonstrated on DTT in a patient with central pain following whiplash injury. Previously, the patient was misdiagnosed as CRPS.
我们报告一例患有挥鞭样损伤的患者，其因脊髓丘脑束（STT）损伤而出现中枢性疼痛，但被误诊为复杂性区域疼痛综合征（CRPS）。
一名43岁女性坐在小型货车副驾驶座位上，车辆因信号灯停下时，一辆卡车从后方撞上该小型货车，随后小型货车又与前后的卡车反复碰撞。她的头部反复撞击小型货车座椅，导致挥鞭样损伤。发病后，她感到双腿疼痛，四肢有轻度运动无力及记忆障碍。发病8年后，她在一家大学医院被诊断为1型CRPS，具有痛觉过敏、双腿轻度水肿及运动无力的临床特征。发病9年后，她前往另一家大学医院就诊，主诉右臂及双腿疼痛、持续的刺痛和灼痛伴感觉异常和痛觉过敏。她还表现出四肢轻度无力、双腿轻度水肿及记忆障碍。在弥散张量纤维束成像（DTT）检查中，左侧脊髓丘脑束（STT）显示明显变窄，右侧STT显示轻度变窄及部分撕裂。此外，双侧皮质脊髓束及右侧皮质网状脊髓束均观察到部分撕裂。左侧皮质网状脊髓束及左侧穹窿脚观察到中断。
在一名挥鞭样损伤后出现中枢性疼痛的患者中，DTT显示脊髓丘脑束损伤。此前，该患者被误诊为CRPS。
