A 50-year-old taxi driver was involved in a rear-end traffic collision. The patient developed the Whiplash Syndrome of occipitonuchal pain and stiffness. The patient complained of decreased vision, and a corrected visual acuity of only 0.2 was documented by an ophthalmologist. No visual field defects were noted. Two months later, the patient complained of a severe headache and was later found unconscious in his car. Initial neurological findings were unresponsiveness, anisocoria (L>R), and increased tonus in the left arm. The patient developed generalized seizures and decerebrate rigidity. The patient did not regain consciousness and died 3 days later of hyperthermia from hypothalamic dysfunction. Computed tomographic (CT) scan before death demonstrated hypodense areas without enhancement of the pons, right side of the hypothalamus, and anterior cerebellum suggestive of basilar infarction. At autopsy, a 1-cm thrombus was found in the right vertebral artery at the level of the transverse foramen of C1. Evidence of recent traumatic dissection was noted at this level. A 2-cm occluding thrombotic embolus was found in the distal basilar artery. The authors note that if the episodic visual disturbances had been recognized as transient ischemic attacks (TIAs), the patient might have benefitted from anticoagulant therapy. They suggest that anticoagulant therapy be considered in patients who develop signs of posterior circulation TIAs after whiplash trauma. The whiplash syndrome of the cervical spine should not be overlooked and treated only fortuitously. Stroke. 1995; 26: 2194.
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