PRACTICE POINTS:
PATHOLOGY
Vertebral artery injury less severe than that producing
whiplash stroke may cause commoner
Whiplash Associated Disorders
Reduced regional blood flow (SPECT) and metabolism
(PET) in the brain accompany neck pain and cognitive difficulties
Velocity-dependent clinical signs developed in whiplash
volunteers examined at 24 hours
Abnormal
posture and balance, and deficits of divided attention, may be characteristic
of Whiplash Associated Disorder
THERAPY
PRACTICE POINTS:
A
course of corticosteroid therapy started within hours of whiplash may significantly
reduce disability
A course of corticosteroid
therapy started within hours of whiplash may significantly reduce disability
LITIGATION
PRACTICE POINTS:
In
Whiplash Litigation, psychiatric assessment should be routine for:
1. Malingering
2.
Depression
3. Pain Syndrome
PROGNOSIS
PRACTICE POINTS:
Methodological
errors of the Quebec Task Force Report on WAD:
1.
selection bias
2. information bias
3. use of confusing and unconventional terminology
4. unsupported conclusions, recommendations
5. inappropriate generalisations
Poorer
prognosis - socio-demographic:
1.
female
2. older
3. having dependents
4.
not in full-time employment
Poorer
prognosis - crash-related:
5.
in a truck or bus
6.
being a passenger
7.
collision with moving object
8.
head-on or perpendicular collision
Poorer
prognosis - driver:
1. history of
neck injury
2. female
3. weight of bullet vehicle
At
least 60% of psychological abnormality is the result, not the cause, of WAD
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Pathology, Therapy,
Litigation, Prognosis
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