Covid-19 Research

Case Report

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Numbness of the Left Leg Caused by Perfusional Deficit in Right Parietal Lobe in a Case of Whiplash-Associated Disorder: Comparison of Imaging Tools for Diagnosis

General Science    Start Submission

Shan-Wen Lui, Kar-Wai Lui, and Shin-Tsu Chang*

Volume5-Issue8
Dates: Received: 2024-06-10 | Accepted: 2024-08-15 | Published: 2024-08-16
Pages: 983-988

Abstract

Background: Since Whiplash-Associated Disorder (WAD) causes severe pain and even disability among patients, early diagnosis and therapy are essential to reduce personal and social costs. Traditionally, the diagnosis of WAD is mainly conducted through the examination of clinical symptoms and anatomical imaging with Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) but not Single-Photon Emission Computed Tomography (SPECT).

Case description: A 24-year-old woman reported having mild headaches and progressive left leg numbness six months after experiencing a whiplash injury during a rear-end motor vehicle crash. MRI, CT, and electromyographic examination of her left leg were all negative, but SPECT of her brain showed decreased activity in the right parieto-occipital lobes.

Conclusion: Our case highlights (1) the clinical significance of hypoperfusion in the parietal lobe inducing leg numbness instead of nerve dysfunction or nerve-to-muscle signal transmission, (2) the evolving usefulness of functional imaging patterns of SPECT, and (3) the concordance between clinical WAD symptoms and the functional imaging findings. We suggest that patients with WAD need study of nuclear scintigraphy of the brain for a more precise diagnosis.

FullText HTML FullText PDF DOI: 10.37871/jbres1978


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Copyright

© 2024 Shan-Wen L, et al. Distributed under Creative Commons CC-BY 4.0

How to cite this article

Shan-Wen L, Kar-Wai L, Shin-Tsu C. Numbness of the Left Leg Caused by Perfusional Defi cit in Right Parietal Lobe in a Case of Whiplash-Associated Disorder: Comparison of Imaging Tools for Diagnosis. J Biomed Res Environ Sci. 2024 Aug 16; 5(8): 983-988. doi: 10.37871/jbres1978, Article ID: JBRES1978, Available at: https://www.jelsciences.com/articles/jbres1978.pdf


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References


  1. Rebbeck T, Sindhusake D, Cameron ID, Rubin G, Feyer AM, Walsh J, Gold M, Schofield WN. A prospective cohort study of health outcomes following whiplash associated disorders in an Australian population. Inj Prev. 2006 Apr;12(2):93-8. doi: 10.1136/ip.2005.010421. PMID: 16595423; PMCID: PMC2564458.
  2. Sterling M, Jull G, Kenardy J. Physical and psychological factors maintain long-term predictive capacity post-whiplash injury. Pain. 2006 May;122(1-2):102-8. doi: 10.1016/j.pain.2006.01.014. Epub 2006 Mar 9. PMID: 16527397.
  3. Carroll LJ, Holm LW, Hogg-Johnson S, Côté P, Cassidy JD, Haldeman S, Nordin M, Hurwitz EL, Carragee EJ, van der Velde G, Peloso PM, Guzman J; Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976). 2008 Feb 15;33(4 Suppl):S83-92. doi: 10.1097/BRS.0b013e3181643eb8. PMID: 18204405.
  4. Sterling M. Whiplash-associated disorder: musculoskeletal pain and related clinical findings. J Man Manip Ther. 2011 Nov;19(4):194-200. doi: 10.1179/106698111X13129729551949. PMID: 23115472; PMCID: PMC3201650.
  5. Yadla S, Ratliff JK, Harrop JS. Whiplash: diagnosis, treatment, and associated injuries. Curr Rev Musculoskelet Med. 2008 Mar;1(1):65-8. doi: 10.1007/s12178-007-9008-x. PMID: 19468901; PMCID: PMC2684148.
  6. Vállez García D, Doorduin J, Willemsen AT, Dierckx RA, Otte A. Altered Regional Cerebral Blood Flow in Chronic Whiplash Associated Disorders. EBioMedicine. 2016 Aug;10:249-57. doi: 10.1016/j.ebiom.2016.07.008. Epub 2016 Jul 14. PMID: 27444853; PMCID: PMC5006659.
  7. Otte A. Pathophysiological interrelated deactivation/activation processes in the exhausted brain after whiplash injury. Hell J Nucl Med. 2019 May-Aug;22(2):92-95. doi: 10.1967/s002449911000. Epub 2019 Jul 7. PMID: 31273349.
  8. Galli S, Aybek S, Chokron S, Moulin T, Magnin E. Modification of both functional neurological symptoms and neuroimaging patterns with a good anatomoclinical concordance: a case report. BMC Neurol. 2019 Nov 4;19(1):270. doi: 10.1186/s12883-019-1475-3. PMID: 31684891; PMCID: PMC6830004.
  9. Sterling M, Jull G, Vicenzino B, Kenardy J. Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery. Pain. 2003 Aug;104(3):509-517. doi: 10.1016/S0304-3959(03)00078-2. PMID: 12927623.
  10. Radanov BP, Di Stefano G, Schnidrig A, Sturzenegger M, Augustiny KF. Cognitive functioning after common whiplash. A controlled follow-up study. Arch Neurol. 1993 Jan;50(1):87-91. doi: 10.1001/archneur.1993.00540010081022. PMID: 8418806.
  11. Otte A, Ettlin TM, Nitzsche EU, Wachter K, Hoegerle S, Simon GH, Fierz L, Moser E, Mueller-Brand J. PET and SPECT in whiplash syndrome: a new approach to a forgotten brain? J Neurol Neurosurg Psychiatry. 1997 Sep;63(3):368-72. doi: 10.1136/jnnp.63.3.368. PMID: 9328255; PMCID: PMC2169690.
  12. Karlsborg M, Smed A, Jespersen H, Stephensen S, Cortsen M, Jennum P, Herning M, Korfitsen E, Werdelin L. A prospective study of 39 patients with whiplash injury. Acta Neurol Scand. 1997 Feb;95(2):65-72. doi: 10.1111/j.1600-0404.1997.tb00071.x. PMID: 9059723.
  13. Sarrami P, Armstrong E, Naylor JM, Harris IA. Factors predicting outcome in whiplash injury: a systematic meta-review of prognostic factors. J Orthop Traumatol. 2017 Mar;18(1):9-16. doi: 10.1007/s10195-016-0431-x. Epub 2016 Oct 13. PMID: 27738773; PMCID: PMC5311004.
  14. Mi XQ, Chen JY, Liang ZJ, Zhou LW. In vitro effects of helium-neon laser irradiation on human blood: blood viscosity and deformability of erythrocytes. Photomed Laser Surg. 2004 Dec;22(6):477-82. doi: 10.1089/pho.2004.22.477. PMID: 15684746.
  15. Wasik M, Gorska E, Modzelewska M, Nowicki K, Jakubczak B, Demkow U. The influence of low-power helium-neon laser irradiation on function of selected peripheral blood cells. J Physiol Pharmacol. 2007 Nov;58 Suppl 5(Pt 2):729-37. PMID: 18204188.
  16. Risacher SL, Saykin AJ. Neuroimaging biomarkers of neurodegenerative diseases and dementia. Semin Neurol. 2013 Sep;33(4):386-416. doi: 10.1055/s-0033-1359312. Epub 2013 Nov 14. PMID: 24234359; PMCID: PMC3975244.
  17. Anarte-Lazo E, Abichandani D, Rodriguez-Blanco C, Bernal-Utrera C, Falla D. Headache features in people with whiplash associated disorders: A scoping review. Musculoskelet Sci Pract. 2023 Aug;66:102802. doi: 10.1016/j.msksp.2023.102802. Epub 2023 Jun 18. PMID: 37357053.
  18. Schollaert J, Van Goethem JWM. Imaging in Whiplash-Associated Disorders. Semin Musculoskelet Radiol. 2023 Oct;27(5):512-521. doi: 10.1055/s-0043-1772170. Epub 2023 Oct 10. PMID: 37816359.
  19. Otte A, Ettlin T, Fierz L, Mueller-Brand J. Parieto-occipital hypoperfusion in late whiplash syndrome: first quantitative SPET study using technetium-99m bicisate (ECD). Eur J Nucl Med. 1996 Jan;23(1):72-4. doi: 10.1007/BF01736993. PMID: 8586106.
  20. Lai MH, Wang TY, Chang CC, Li TY, Chang ST. Cerebellar diaschisis and contralateral thalamus hyperperfusion in a stroke patient with complex regional pain syndrome. J Clin Neurosci. 2008 Oct;15(10):1166-8. doi: 10.1016/j.jocn.2007.06.017. Epub 2008 Aug 15. PMID: 18707887.
  21. Hsu KC, Chang ST. Correlation of thalamic blood flow redistribution with persistent complex regional pain syndrome in a stroke patient with poor diabetic control. J Diabetes Investig. 2013 Nov 27;4(6):676-8. doi: 10.1111/jdi.12104. Epub 2013 Jul 12. PMID: 24843725; PMCID: PMC4020266.
  22. Chang CC, Ku CH, Chang ST. Postural asymmetry correlated with lateralization of cerebellar perfusion in persons with chronic stroke: A role of crossed cerebellar diaschisis in left side. Brain Inj. 2017;31(1):90-97. doi: 10.1080/02699052.2016.1210229. Epub 2016 Nov 10. PMID: 27830942.
  23. Yang WH, Lin SP, Chang ST. Case report: Rapid improvement of crossed cerebellar diaschisis after intravascular laser irradiation of blood in a case of stroke. Medicine (Baltimore). 2017 Jan;96(2):e5646. doi: 10.1097/MD.0000000000005646. PMID: 28079797; PMCID: PMC5266159.
  24. He HC, Hsu MC, Hsu CS, Cheng YY, Chang ST. Bidirectionality of the dentato-rubro-thalamo-cortical tract allows concurrent hypoperfusion in ipsilateral cerebellum and contralateral cerebral hemisphere: A case report. Medicine (Baltimore). 2018 Oct;97(40):e12590. doi: 10.1097/MD.0000000000012590. PMID: 30290625; PMCID: PMC6200509.
  25. Chuang YC, Liu CC, Yu IC, Tsai YL, Chang ST. Shifting of global aphasia to Wernicke's aphasia in a patient with intact motor function: a case report. BMC Neurol. 2021 Mar 11;21(1):111. doi: 10.1186/s12883-021-02131-w. PMID: 33706719; PMCID: PMC7949244.
  26. Effects of intravascular laser phototherapy on delayed neurological sequelae after carbon monoxide intoxication as evaluated by brain perfusion imaging: A case report and review of the literature.
  27. Li SA, Lin YP, Hsieh SP, Chang ST. Binary effects of intravascular laser irradiation of blood on motor recovery and homocysteine reduction in a case with ischemic hemiparesis: portrayed with brain perfusion images. BMC Neurol. 2022 Sep 27;22(1):370. doi: 10.1186/s12883-022-02896-8. PMID: 36162998; PMCID: PMC9513988.
  28. Lan CH, Wu YC, Chiang CC, Chang ST. Effects of intravascular photobiomodulation on motor deficits and brain perfusion images in intractable myasthenia gravis: A case report. World J Clin Cases. 2022 Aug 26;10(24):8718-8727. doi: 10.12998/wjcc.v10.i24.8718. PMID: 36157830; PMCID: PMC9453358.
  29. Chiang CC, Wu YC, Lan CH, Wang KC, Tang HC, Chang ST. Exploring CNS Involvement in Pain Insensitivity in Hereditary Sensory and Autonomic Neuropathy Type 4: Insights from Tc-99m ECD SPECT Imaging. Tomography. 2023 Dec 18;9(6):2261-2269. doi: 10.3390/tomography9060175. PMID: 38133079; PMCID: PMC10747491.
  30. Chu YC, Chang ST, Chan HY, Shen DHY, Chan HP. Abnormalities in regional cerebral blood flow due to headache in a COVID-19 infected patient observed on 99 mTC-ECD brain SPECT/CT. Reports. 2023;6(4):58. doi: 10.3390/reports6040058.
  31. Chen HH, Lin CY, Chen SJ, Huang WY, Kuo CW, Chang ST. Intravascular laser irradiation of blood as novel migraine treatment: an observational study. Eur J Med Res. 2023 Oct 25;28(1):457. doi: 10.1186/s40001-023-01438-3. PMID: 37876003; PMCID: PMC10598972.
  32. Lin YP, Ku CH, Chang CC, Chang ST. Effects of intravascular photobiomodulation on cognitive impairment and crossed cerebellar diaschisis in patients with traumatic brain injury: a longitudinal study. Lasers Med Sci. 2023 Apr 20;38(1):108. doi: 10.1007/s10103-023-03764-8. PMID: 37076743; PMCID: PMC10115718.
  33. Tanaka K, Yamada T, Torii T, Yoshimura T, Takase K, Togao O, Wakata Y, Hiwatashi A, Nakashima N, Kira J, Murai H. Pure dysarthria and dysarthria-facial paresis syndrome due to internal capsule and/or corona radiata infarction. BMC Neurol. 2015 Oct 7;15:184. doi: 10.1186/s12883-015-0439-5. PMID: 26445963; PMCID: PMC4597455.
  34. Masdeu JC, Brass LM. SPECT imaging of stroke. J Neuroimaging. 1995 Jul;5 Suppl 1:S14-22. doi: 10.1111/jon19955s1s14. PMID: 7626832.
  35. Laloux P, Richelle F, Jamart J, De Coster P, Laterre C. Comparative correlations of HMPAO SPECT indices, neurological score, and stroke subtypes with clinical outcome in acute carotid infarcts. Stroke. 1995 May;26(5):816-21. doi: 10.1161/01.str.26.5.816. PMID: 7740573.
  36. Elliott JM, Dayanidhi S, Hazle C, Hoggarth MA, McPherson J, Sparks CL, Weber KA 2nd. Advancements in Imaging Technology: Do They (or Will They) Equate to Advancements in Our Knowledge of Recovery in Whiplash? J Orthop Sports Phys Ther. 2016 Oct;46(10):862-873. doi: 10.2519/jospt.2016.6735. PMID: 27690836; PMCID: PMC7274526.


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