Arterial dissection is a recognised complication of neck manipulation and trauma. In a systematic audit of 148 complex medicolegal whiplash cases 131 had only neck pain, 8 had radiculopathic symptoms, and 9 had symptoms and signs suggesting an arterial dissection of a neck vessel with presumed secondary thromboembolism.
Their ages ranged from 28–55. Three had hemipareses supported by scan abnormalities, and one had a probable posterior fossa stroke. Five cases had prolonged symptoms without imaging abnormalities.
This series cannot be considered representative of whiplash cases as a whole. The dissection is necessarily conjectural, though the patients were young without conventional risk factors. None were investigated when they developed focal symptoms, and were only seen as part of their injury claim some time afterwards, when the artery is likely to have recanalised.
The rate of thrombotic complications in arterial dissection is low. All our cases had focal symptoms, and they could represent the tip of a dissection ‘iceberg’ – we suggest that the incidence of arterial dissection in whiplash should be investigated by a prospective study in Accident and Emergency departments. Perhaps the administration of aspirin to every patient might lower the incidence of thrombotic complications, at minimal risk.
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