%0 Journal Article
%T Vertebral artery injury and third-party liability: the wrongful attack to whiplash injury, L.27/12 (G.U. n.71 del 24.03.12)
%A Perotti S
%A Bin Paola
%J Prevention and Research : International Open Access Journal of Prevention and Research in Medicine
%D 2012
%I Prevention and Research
%R 10.7362/2240-2594.042.2012
%X Lesions after blunt cervical trauma could be, infrequently, associated with complications that require a discussion under clinical and legal medical point of view. Vertebral artery dissection as a serious consequence of a cervical trauma is a rare complication of patients with blunt injury mechanisms. Artery lesions could be frequently initially unrecognized or they may present a variety of symptoms ranging from a simple pain involving neck to ischemic lesions and cerebral ictus. Arterial dissection can cause ischemic stroke either by thromboemboli forming at the site of injury or as a result of hemodynamic insufficiency due to severe vascular stenosis or occlusion.In medical literature several injury hypotheses which may cause a dissection of the arterial walls of vertebral arteries have been analyzed. Among them, repeated micro-traumatism which, acting on already altered wall, cause the dissection. Some jobs or sports are characterized by this risk because they imply frequent and repeated flexo-extension movements or head rotations. Also a single minor trauma, such as a blunt cervical trauma following car accident, could cause the dissection of the vertebral arterial wall.The case reported concerns a 43 year-old man who suffered a bruising trauma following a car accident (a bumper-to-bumper crash with an articulated lorry). The reported symptomatology consisted of pain along the rachis and on the back on the neck and a diagnosis of cervical whiplash was made. After the worsening of the symptomatology, neurological tests revealed right hemiataxia and dysarthria. Succeeding MRI scanning with angiographic sequences revealed a dissection of the left vertebral artery with a hyperdense lesion of the right cerebellar hemisphere, as an outcome of an infarct in the area of a postero-inferior cerebellar artery. Vertebral artery stretch during trauma is a possible pathogenic mechanism that could explain some aspects of the whiplash symptom complex and serious consequences.At the present this issue shows many controversial points from a pathogenetic point of view. The described uncertainties and the rareness of this kind of injury may explain the ¡°superficiality¡± of a doctor giving first-aid to a patient with cervical whiplash and ¡°generic¡± symptoms and it could be related to possible economical benefits consequent from insurance indemnity.However the persistence of symptoms or the negative evolution of the same suggests that it wasn¡¯t the ¡°usual whiplash invented for compensation purposes¡± and that late complications of an injury of the walls of encephalic arter
%K vertebral artery injury
%K whiplash
%K rare complication
%K medical-legal evaluation
%U http://www.preventionandresearch.com/vertebral-artery-injury-and-third-party-liability-the-wrongful-attack-to-whiplash-injury-l27-12-gu-n71-del-240312.html