fMRI Response During Visual Motion Stimulation in Patients with Late Whiplash Syndrome

Abstract

After whiplash trauma, up to one fourth of patients develop chronic symptoms including head and neck pain and cognitive disturbances. Resting perfusion single-pho ton-emission computed tomography (SPECT) found decreased temporoparietooccipi tal tracer uptake among these long-term symptomatic patients with late whiplash syn drome. As MT/MST (V5/V5a) are located in that area, this study addressed the question whether these patients show impairments in visual motion perception. We examined five symptomatic patients with late whiplash syndrome, five asymptomatic patients after whiplash trauma, and a control group of seven volunteers without the history of trauma. Tests for visual motion perception and functional magnetic resonance imaging (fMRI) measurements during visual motion stimulation were performed. Symptomatic patients showed a significant reduction in their ability to perceive coherent visual motion com pared with controls, whereas the asymptomatic patients did not show this effect. fMRI activation was similar during random dot motion in all three groups, but was signifi cantly decreased during coherent dot motion in the symptomatic patients compared with the other two groups. Reduced psychophysical motion performance and reduced fMRI responses in symptomatic patients with late whiplash syndrome both point to a functional impairment in cortical areas sensitive to coherent motion. Larger studies are needed to confirm these clinical and functional imaging results to provide a possi ble additional diagnostic criterion for the evaluation of patients with late whiplash syn drome. Key Words: Whiplash—fMRI—Visual motion perception.

References

Kischka U. , Ettlin TM , Heim S. , et al. Cerebral sypmtoms following whiplash injury. Eur Neurol 1991;31:136-40.

Jacobs A. , Put E. , Ingels M. , et al. One year follow-up of technetium-99m-HMPAO SPECT in mild head injury. J Nucl Med 1996;37:1605-9.

Radanov BP , Sturzenegger M. , Schnidrig A.

Relationship between early somatic, radiological, cognitive and psychological findings and outcome during a one-year follow-up in 117 patients suffering from common mhiplash. Br

J Rheum 1994;33:442-8.

Gimse R. , Tjell C. , Bjorgen IA , et al. Disturbed eye movements after whiplash due to injury to the posture control system. J Clin Exp Neuropsychol 1996;18:178-86.

Otte A. , Ettlin TM , Fierz L. , et al. Brain perfusion patterns in 136 patients with chronic symptoms after torsion of the cervical spine using single photon emission computed tomography, technetium-99m-HMPAO and technetium-99m-ECD: a controlled study . J Vasc Invest 1997;3:1-5.

Otte A. , Ettlin TM , Mueller-Brand J. Comparison of 99m-Tc-ECD with 99m-Tc-HMPAO-brain-SPECT in late whiplash syndrome . J Vasc Invest 1995;1:157-63.

Otte A. , Ettlin TM , Nitzsche EU , et al. PET and SPECT in whiplash syndrome: a new approach to a forgotten brain? JNNP 1997;63:368-72.

Otte A. , Mueller-Brandt J. , Fierz L. Brain SPECT findings in late whiplash syndrome. Lancet 1995;345:1513-4.

Alexander MP In the pursuit of proof of brain damage after whiplash injury. Neurology 1998;51:336-40.

10.

Corbetta M. , Miezin FM , Dobmeyer S. , et al. Selective and divided attention during visual discriminations of shape, color and speed: functional anatomy by positron emisssion tomography. J Neurosci 1991;1:2383-402.

11.

Zeki S. , Watson Jdg , Lueck CJ , et al. A direct demonstration of functional specialization in human visual cortex. J Neurosci 1991;11:641-9.

12.

Watson JD , Myers R. , Frackowiak RS , et al. Area V5 of the human brain: evidence from a combined study using positron emission tomography and magnetic resonance imaging. Cereb Cortex 1993;3:79-94.

13.

Cheng K. , Fujita H. , Kanno I. , et al. Human cortical regions activated by wide field visual motion: An H215O PET study. J Neurophysiol 1995;74:413-27.

14.

Tootell Rhb , Mendola JD , Hadjikhani NK , et al. Functional analysis of V3A in related areas in human visual cortex. J Neurosci 1995 ;17:7060-78.

15.

Dupont P. , De Bruyn B. , Vandenberghe R. The kinetic occipital region in human visual cortex. Cereb Cortex 1997;7:283-92.

16.

Talairach J. , Tournoux P. Co-planar stereotaxic atlas of the human brain. Stuttgart : Thieme, 1988.

17.

Smith AT , Greenlee MW , Singh KD , et al. The processing of first-and second-order motion in human visual cortex assessed by functional magnetic resonance imaging (fMRI). J Neurosci 1998;18: 3816-30.

18.

Cox R. AFNI: software for analysis and visualization of functional magnetic neuroimages . Comput Biomed Res 1996;29:162-73.

19.

Freitag P. , Greenlee MW , Lacina T. , et al. Effect of eye movements on the magnitude of fMRI responses in extrastriate cortex during visual motion perception. Exp Brain Res 1998;119:409-14.

20.

Spitzer WO , Skovron ML , Salmi LR , et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. Spine 1995;20: 1S-73S.

21.

Bogduk N. , Teasell R. Whiplash. Arch Neurol 2000;57:590-1.

22.

Cassidy JD , Carroll LJ , Côté P. , et al. Effect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury. N Engl J Med 2000;342:1179-86.

23.

Obelieniene D. , Schrader H. , Bovim G. , et al. Pain after whiplash: a prospecitve controlled inception cohort study. JNNP 1999 ;66: 279-83.

24.

Pearce Jms. A critical appraisal of the chronic whiplash syndrome. JNNP 1999;66:273-6.

25.

Bicik I. , Radanov BP , Schaefer N. , et al. PET with 18fluorodeoxyglucose and HMPAO SPECT in late whiplash syndrome. Neurology 1998;51:345-50.

26.

Ichise M. , Chung D-G. , Wang P. , et al. Tc-99m-HMPAO SPECT, CT and MRI in the evaluation of patients with chronic traumatic brain injury: a correlation with neuropsychological performance. J Nucl Med 1994;35:217-26.

27.

O'Craven KM , Rosen BR , Kwong KK , et al. Voluntary attention modulates fMRI activity in human MT/MST. Neuron 1997;18: 591-8.

28.

Beauchamp MS , Cox RW , De Yoe EA. Graded effects of spatial and featural attention on human area MT and associated motion processing areas . J Neurophysiol 1997;78:516-20.

29.

Kastner S. , Pinsk MA , De Weerd P. , et al. Increased activity in human visual cortex during directed attention in the absence of visual stimulation. Neuron 1999;22:751-61.

30.

Plant GT , Laxer KD , Barbaro NM , et al. Impaired visual motion perception in the contralateral hemifield following unilateral posterior cerebral lesions in humans. Brain 1993;116:1303-35.

31.

Barton Jjs , Sharpe JA , Raymond JE Retinotopic and directional defects in motion discrimination in humans with cerebral lesions. Ann Neurol 1995;37:665-75.

32.

Greenlee MW , Lang H-J. , Mergner T. , et al. Visual short term memory of stimulus velocity in patients with unilateral posterior brain damage. J Neurosci 1995;15:2287-300.

33.

Greenlee MW , Smith AT Detection and discrimination of first-and second-order motion in patients with unilateral brain clam-age. J Neurosci 1997; 17:804-18.

34.

Kimmig H. , Pinow C. , Mergner T. , et al. Smooth pursuit eye movements in patients with impaired visual motion perception. In: Mergner T , Hlavacka F , eds. Multisensory control of posture . New York: Plenum Press, 1995:325-9.

35.

Barton Jjs , Sharpe JA , Raymond JE Directional defects in pursuit and motion perception in humans with unilateral cerebral lesions. Brain 1996; 119:1535-9.