gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

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?

Meeting Abstract

Suche in Medline nach

  • corresponding author Maximilian J. A. Puchner - Neurochirurgische Klinik, Krankenanstalten Gilead, Bielefeld
  • F. Oppel - Neurochirurgische Klinik, Krankenanstalten Gilead, Bielefeld

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 14.151

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0435.shtml

Veröffentlicht: 23. April 2004

© 2004 Puchner et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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.