Article
The causal link between a rear-end collision and a delayed vertebral artery dissection: How can medical expert opinion judge this best?
Der kausale Zusammenhang zwischen einem Auffahrunfall und einer verzögerten Dissektion der A. vertebralis: Wie fällt die Begutachtung aus?
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Authors
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Maximilian J. A. Puchner
- Neurochirurgische Klinik, Krankenanstalten Gilead, Bielefeld
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F. Oppel
- Neurochirurgische Klinik, Krankenanstalten Gilead, Bielefeld
| Published: | April 23, 2004 |
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Outline
Text
Objective
First symptom of a vertebral artery-dissection (VAD) is a strong neck-pain. Neurological symptoms classically develop with a delay of weeks. Epidemiologically, the incidence of traumatic VAD is much higher than the one of spontaneous VAD. The lesion in traumatic VAD is located in the intertransversal segment, that of a spontaneous VAD in the atlanto-axial segment. The aim of this report is to show evidence to judge the causal link between a rear-end collision and a VAD, diagnosed 16 months thereafter.
Methods
The court asked for an expert opinion to decide the question, whether a VAD was caused by a rear-end collision which had occurred 16 months before. To answer this question, the patient was re-examined, the files, MRI and ultrasound-scans were studied and research of the literature was done.
Case report
A 29-year-old female experienced a rear-end-collision, sitting in the car in front. The resulting whiplash injury was classified as Erdmann, grade III. 16 months after the trauma she developed a sudden onset of right-sided lower cranial nerve disturbances. In a neurological department, a Wallenberg-syndrome was diagnosed which was found to be caused by a dissection of the right vertebral artery (MRI, Ultrasound). In spite of the trauma 16 months ago, the patient’s history was free of any other risk factors, known to be associated with an increased incidence of VAD (oral contraceptives, migraine, vascular disease, smoking, age above 40 years).
Conclusions
The following arguments were found in the literature to support the assumption of a causal link: (1) location of the VAD, (2) strength of whiplash injury, (3) young age of patient (<40y), (4) missing VAD-risk-factors, and (5) no other trauma after initial accident. As a report was found describing an onset of neurological symptoms due to a VAD many months after an accident, the main argument against a causal link was weakened. Therefore we decided in the present case that the likelihood of a causal link between injury and traumatic VAD is much higher that the development a spontaneous VAD independent of a cervical trauma.
