Abstract
Objectives: This study investigated injuries of the ascending reticular activating system (ARAS) following whiplash injury, in patients with excessive daytime sleepiness (EDS).Methods: Twenty-three patients with whiplash injury and 26 healthy control subjects were recruited for this study. Epworth Sleepiness Scale (ESS) was used for evaluating sleepiness. According to the ESS score, the patients were classified into two groups: subgroup A – ESS score <10, and subgroup B – ESS score ≥10. Three components of the ARAS (lower dorsal, lower ventral, and upper) were evaluated for fractional anisotropy (FA) and tract volume (TV).Results: No significant differences were observed in the FA and TV values of the lower dorsal and upper ARAS between the patient and control groups (p > 0.05). Conversely, the values of FA and TV in the lower ventral ARAS of the patient group were significantly lower than those of the control group (p < 0.05). Comparing the values of subgroups A and B, the TV value of subgroup B was significantly lower than subgroup A (p < 0.05). However, no significant differences were observed in the values of the FA and TV in the lower dorsal and upper ARAS, and the FA value in the lower ventral ARAS (p > 0.05).Conclusions: We found significant injury of the lower ventral ARAS in EDS patients with whiplash injury. These results suggest that diffusion tensor tractography (DTT) could provide useful information for detecting injuries of the ARAS following whiplash injury, in patients with EDS.
Highlights
Whiplash is a bony or soft tissue injury resulting from an acceleration-deceleration mechanism of energy transfer to the neck (Spitzer et al, 1995)
No significant differences were observed in the fractional anisotropy (FA) and tract volume (TV) values of the lower dorsal and upper ascending reticular activating system (ARAS) between the patient and control groups (p > 0.05)
The values of FA and TV in the lower ventral ARAS of the patient group were significantly different than the control group (p < 0.05)
Summary
Whiplash is a bony or soft tissue injury resulting from an acceleration-deceleration mechanism of energy transfer to the neck (Spitzer et al, 1995). Various symptoms suggesting brain injury, including sleeping problems, cognitive impairment, visual impairment, and vestibular symptoms, have been reported following whiplash injury (Ettlin et al, 1992). Previous studies on functional neuroimaging, brain MRI and dissection of post-mortem brain have suggested evidences of brain injury following whiplash injury (Otte et al, 1997; Obermann et al, 2009; Vállez García et al, 2016). Since the introduction of diffusion tensor imaging (DTI), is a technique that allows. Patient group (n = 23) Subgroup B (n = 14) Total. Sex (male: female) Mean age, years ESS LOC, minutes PTA, minutes GCS score Mean duration to DTI (months).
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