Can Whiplash Cause Concussion?

Can Whiplash Cause Concussion?

Dr. Alan Himmel

Talked about it before.  Let's talk about it again.  Can a mild whiplash cause a concussion?  The literature says, yes.  And, I have had several patients over the years, and one currently, who has the affects of post concussion syndrome.

Attorneys who represent injury clients need to be aware of this issue as well.  The most recent patient that I am treating who I am sure has suffered a concussion, has all of the symptoms of this injury, including headache, vertigo, disorientation, and confusion.  This will be a patient who will tell you that their head just doesn't feel the same since the accident.  It can be very frustrating to the patient, and the patient may find themselves searching doctors who could figure it out.  Oddly enough, attorneys will very often dismiss concussion, wanting to focus the claim on disc injuries and the usual soft tissue findings. Why?

I think that the major sticking point for attorneys is simply not understanding the physics involved in a car accident, and not knowing what a concussion actually is.

You don't have to strike your head against the inside of the car and you don't have to get hit in the head by something to cause concussion.  Think of it like this:  The brain is encased within the skull and around the brain is a thin layer of fluid which separates the brain from the inside of the skull so it does not touch (among other purposes of the fluid). The fluid is called cerebral spinal fluid or CSF.  So, the brain, in a way, is swimming in this fluid and the small fluid space between the brain and the inside surface of the skull is like a barrier because you don't want the brain to touch anything.

Okay, now think about what will happen to a person's head when at rest, when the car he is in is hit from behind.  The person's head will move in the direction of where the force came from.  This is one of Newton's laws of motion.  Every action has an equal and opposite reaction.  But, what about the brain which is "floating" within the skull?  It too, must obey the laws of physics, and at this point, the brain will then crash into the inside of the skull on the opposite side.  Right there is your concussion.



Now, keep in mind that concussion is not always possible to see on MRI or CAT scan.  Concussion is regularly diagnosed based on neurological symptoms, signs, and complaints.  Lawyers and insurance companies want objective proof, but they cannot always have it with concussion.  The lawyer who is representing the client with concussion, must be aware of these things.  A lawyer who is representing injury clients must be an expert in the law, and although its not required to be trained like a physician, he should also have a working knowledge of different types of injuries involved.

So, keep an eye out for a concussion when whiplash is involved.  They are generally not life threatening, but concussions can be quite serious, and recurrent concussions can be even worse.

I can be reached at 954-659-8600

My office address is:

Alan Himmel, DC, PA.
3161 Dykes Road
Miramar, FL. 33027

WHIPLASH, POST CONCUSSION SYNDROME, MILD TRAUMATIC BRAIN INJURY, Emergency Medical Condition, EMC.

          WHIPLASH, POST CONCUSSION SYNDROME, MILD TRAUMATIC BRAIN INJURY.  Emergency Medical Condition.  EMC.

Dr. Alan Himmel

I thought this would be an interesting topic due to the fact that symptoms of concussion due to whiplash, many times are routinely overlooked.  Many times, a patient seeks treatment for whiplash pain due to an auto accident, only to be treated for the typical musculo-skeletal symptoms and neurological symptoms, which include but is not limited to neck pain, shoulder pain, radiating extremity pain, tingling and numbness.  These complaints are almost universal among whiplash victims.

But what about other symptoms like headache, vertigo, fatigue, irritability, impaired memory?  The more severe case includes convulsions, loss of hearing, seizures, and loss of consciousness.  (5) Over the years I have had dozens of patients tell me that ever since the accident, they feel like they are "in a fog."    They describe it as the inability to think clearly.  If you are a healthcare practitioner you should be cognizant of these post concussion symptoms as they are commonly caused by automobile accidents, and they are an indication that the patient may have a mild traumatic brain injury.  (1)  If you are a patient who is experiencing any of the above signs or symptoms, please do not ignore this potential emergency medical condition.  Misdiagnosing or ignoring this altogether could lead to serious and permanent long term disability.

It has been estimated that there are between 1.6 million and 3.8 million individual cases of injuries that cause post-concussion-symptoms. (2) And, concussions are seen in approximately 6 in every 1000 injuries. (3) I often wonder how much higher this number would be if all cases were diagnosed, because many people never seek medical care.  There are a lot of variables here.  In fact, this is an injury that is very prevalent in athletics and contact sports, like football and ice hockey, but on the amateur level, many times these mild traumatic brain injuries are simply ignored.  Time and time again, I even see the diagnosis of concussion being missed by physicians at emergency departments.

The concussion could occur when there is an impact to the head, or the head is thrown around due to  unexpected forces to the body, such as from a car crash, a serious football tackle, etc.

The image above shows how the brain which is surrounded by fluid for protection, is moved forcefully and collides with the inside of the skull.  

The image above shows the resulting bruise to the brain, which has just crashed into  the  inside of the skull.

To get an idea of the potential seriousness of these types of head injuries, you don't have to look very far.  There have been several incidents in professional sports, particularly football, where it is has been shown that repeated concussions to the brain caused very serious and chronic outcomes.  Over the long haul, patients who have had concussions suffer from depression, chronic headaches, mood swings, early dementia, memory problems and other psychological disorders.(4)

Treatment for concussion generally involves rest, including cognitive rest, by eliminating anything that requires concentration or memory, including taking time off from school.  Reducing physical activity is important and generally if the injury happened playing sports, the individual would be taken out of the game for a while, at least until all the symptoms have disappeared.  Once the patient is symptom free, he must be gradually be introduced back into the physical activity in small steps.  You don't want to just throw yourself back into the game, as symptoms could return.

You have to listen to what the patient has to say and do a thorough exam.  Be aware that there a lot of forces involved even in small impact collisions.  Don't overlook or brush it off when a patient tells you that since the accident they are having a hard time concentrating.  Put the pieces together.  You may have a case of post concussion syndrome which is an Emergency Medical Condition or EMC.



1.  Rehabil Res Pract. 2012;2012:528265. doi: 10.1155/2012/528265. Epub 2012 May 22.

Postconcussion symptoms in patients with injury-related chronic pain.

Stålnacke BM.

Source

Department of Community Medicine and Rehabilitation, Umeå University Hospital, Umeå University, Building 9A, 90185 Umeå, Sweden.  

2..Phys Sportsmed. 2012 Nov;40(4):73-87. doi: 10.3810/psm.2012.11.1990.

Postconcussion syndrome: a review of pathophysiology and potential nonpharmacological approaches totreatment.

Maroon JC, Lepere DB, Blaylock RL, Bost JW.

Source

Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. maroonjc@upmc.edu

3.   Cassidy JD, Carroll LJ, Peloso PM, Borg J, von Holst H, Holm L, et al. (2004). "Incidence, risk factors and prevention of mild traumatic brain injury: Results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury". Journal of Rehabilitation Medicine 36 (Supplement 43): 28–60. doi:10.1080/16501960410023732. PMID 15083870

4.   Cantu RC (2007). "Chronic traumatic encephalopathy in the National Football League".Neurosurgery 61 (2): 223–5.  PMID 17762733 

5.  "Information about NICE clinical guideline" (PDF). National Institute for Health and Clinical Excellence. September 2007. Retrieved 2008-01-26.