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ANALGESIA

Epidural Blood Patch Therapy for Chronic Whiplash-Associated Disorder

Shinichi Ishikawa, MD^*, Masataka Yokoyama, MD, Satoshi Mizobuchi, MD, Hidenori Hashimoto, MD^*, Eiji Moriyama, MD, and Kiyoshi Morita, MD

From the *Department of Anesthesiology, Fukuyama Kohnan Hospital, Kohnan-cho, Fukuyama City, Hiroshima, Japan; Department of Anesthesiology and Resuscitology, Okayama University Medical School, Shikata-cho, Okayama City, Okayama, Japan; Department of Neurosurgery, National Hospital Organization Fukuyama Medical Center, Okinogami-cho, Fukuyama City, Hiroshima, Japan.

Address correspondence and reprint requests to Masataka Yokoyama, MD, Department of Anesthesiology and Resuscitology, Okayama University Medical School, 2-5–1, Shikata-cho, Okayama City, Okayama 700-8558, Japan. Address e-mail to masayoko{at}cc.okayama-u.ac.jp.

Abstract

BACKGROUND: Despite the absence of objective neurological deficits, patients with chronic whiplash-associated disorder (WAD) complain of symptoms such as headache, dizziness, and nausea. These symptoms are also often experienced by patients with cerebrospinal fluid (CSF) leak. It was recently reported that radioisotope (RI) cisternography is useful in the diagnosis of intracranial hypotension due to CSF leak. We investigated the relation between chronic WAD and CSF leak by RI cisternography and evaluated whether epidural blood patch (EBP) administration is effective in the treatment of chronic WAD.

METHODS: We studied 66 patients with chronic WAD with symptoms lasting longer than 3 mo. All patients underwent RI cisternography to determine the presence of CSF leak. In patients in whom CSF leak was identified, EBP was administered. Symptoms were assessed before, 1 wk after, and 6 mo after EBP. Work status was also assessed and follow-up RI cisternography was performed.

RESULTS: Of the 66 patients, 37 showed CSF leak, and 36 of these patients received EBP 2.2 ± 0.7 times. The mean duration of symptoms was 33 mo. One week after EBP, the percentage of patients with symptoms was decreased significantly compared with that before EBP; headache: 100% vs 17%, respectively, memory loss: 94% vs 28%, dizziness: 83% vs 47%, visual impairment: 81% vs 25%, nausea: 78% vs 42% (P < 0.01). These effects were also observed at the 6 month follow-up examination (P < 0.01). Work status was also significantly improved at follow-up.

CONCLUSIONS: We conclude that CSF leak should be considered in some cases of chronic WAD and that EBP is an effective therapy for chronic WAD.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999