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November 17, 1978

Vertigo Following Whiplash— Vertebral Artery Injury?

Author Affiliations

LaGrange, Ill

JAMA. 1978;240(21):2246. doi:10.1001/jama.1978.03290210028008

To the Editor.—  In the case of whiplash cited in QUESTIONS AND ANSWERS (239:2485, 1978), the symptoms included the loss of consciousness, the sudden onset of vertigo and vomiting ten days following injury, persistent neck stiffness for 2 1/2 years, and vertigo and nausea provoked by head movements.The discussion related these symptoms to the vestibular apparatus and to the nonspecific "cervical vertigo." Another point of view would be to focus on the specific pathology of the vertebral artery. The interosseous course of the vertebral artery renders it vulnerable to injury with the cervical spine. A minor intimal injury may give rise to a propagating thrombus and lead to the delayed onset of acute symptoms by the mechanisms of embolism, brain-stem ischemia due to vertebral artery occlusion, or brainstem infarction due to the extension of thrombus into the posterior inferior cerebellar and basilar arteries.1,2Rare though it appears, the