むち打ち損傷後に発症した低髄液圧症候群の臨床的検討

抄録

In recent years, some case reports have inidicated the presence of intracranial hypotension accompanied with headache, neck pain, and vertigo after whiplash injury, but there are many questions about the pathophysiology.
The aim of the present study was the verification of clinical manifestations and MRI findings in 7 cases of abnormal RI cisternogram after whiplash injury.
RI cisternogram showed the early appearance of radioactivity in the kidneys and urinary bladder, suggesting CSF leakage in the 7 cases. The site of CSF leakage was at the cervicothoracic level in 1, spinal level in 5, and uncertain in the remaining case. Cervical MRI showed no abnormality related to spinal cord compression or CSF leakage. MRI of the head showed subdural fluid collection in 2 cases and brain sinking accompanied with descent of the cerebellar tonsils in 1 case. Clinical features included orthostatic headache, neck pain or stiffness, visual disturbance, dizziness and early fatigue in all 7 cases. Lower back pain was reported in 6, slight fever in 5, vertigo in 4, tinnitus in 4, and dyshidrosis in 1.
Our results suggest that intracranial hypotension may be caused by whiplash injury. The causal relationship with whiplash injury, action mechanism, and treatment are important future considerations.