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一例“轻微”创伤导致严重残疾的病例报告:挥鞭样损伤相关的吞咽困难、发音障碍和味觉障碍。

A case report of "minor" trauma leading to a major disability: whiplash-associated dysphagia, dysphonia, and dysgeusia.

作者信息

Schattner Ami, Glick Yair

机构信息

The Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel.

Department of Imaging, Sanz Medical Centre, Ariel University, Netanya, Israel.

出版信息

J Trauma Inj. 2022 Jun;35(2):115-117. doi: 10.20408/jti.2021.0043. Epub 2022 May 19.

Abstract

"Whiplash"-type injuries are commonly encountered and often cause neck pain, neck stiffness, and headaches. However, these injuries can have rare and poorly recognized complications, such as the development of a prevertebral hematoma leading to acute respiratory failure in the emergency department, followed by severe, life-threatening dysphagia and recurrent aspirations. In the patient described herein, a whiplash injury was accompanied by vocal cord paralysis and dysphonia (vagus nerve), dysgeusia (glossopharyngeal nerve, vagus nerve), and upper esophageal spasm (cricopharyngeal muscle, vagus nerve). It is unlikely that this was a complication of cervical fusion surgery. Instead, a combined stretch-induced lower cranial nerve injury, possibly on the exit of these nerves through the jugular foramen, seems to be a likely, but underappreciated mechanism occurring in rare instances of whiplash injuries.

摘要

“挥鞭样”损伤很常见,常导致颈部疼痛、颈部僵硬和头痛。然而,这些损伤可能会出现罕见且认识不足的并发症,比如在急诊科发生椎前血肿导致急性呼吸衰竭,随后出现严重的、危及生命的吞咽困难和反复误吸。在本文所述的患者中,挥鞭样损伤伴有声带麻痹和发音障碍(迷走神经)、味觉障碍(舌咽神经、迷走神经)以及食管上段痉挛(环咽肌、迷走神经)。这不大可能是颈椎融合手术的并发症。相反,一种联合的牵张性下颅神经损伤,可能发生在这些神经通过颈静脉孔穿出时,似乎是挥鞭样损伤罕见病例中一种可能但未得到充分认识的机制。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/43cb/11309184/bc5e9b6fb9ca/jti-2021-0043f1.jpg

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