Vertebral artery injury and third-party liability: the wrongful attack to whiplash injury, L.27/12 (G.U.n.71 del 24.03.12)

Abstract

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. Vertebral artery injury and third-party liability: the wrongful attack to whiplash injury, L. 27/12 (G.U. n.71 del 24.03.12) www.preventionandresearch.com 311 Oct-Dec 2012|P&R Scientific|Volume 2|N°4 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 flexoextension 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-tobumper 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 arteries must be taken into serious consideration specially under clinical point of view.