Evidence for peripheral neuroinflammation after acute whiplash

Area of Science:

• Neuroscience
• Musculoskeletal Medicine
• Radiology

Background:

• Whiplash-associated disorder grade II (WADII) presents with neck complaints and musculoskeletal signs, often without clear neurological deficits.
• A subset of WADII patients may have underlying peripheral neuroinflammation, contributing to poor prognosis and high socioeconomic costs.

Purpose of the Study:

• To investigate the presence of peripheral neuroinflammation in acute WADII.
• To correlate neuroinflammation indicators with clinical presentations and imaging findings.

Main Methods:

• Recruited 122 WADII participants and 43 healthy controls (HCs).
• Utilized T2-weighted MRI of the brachial plexus, dorsal root ganglia, and median nerve.
• Assessed clinical surrogates: heightened nerve mechanosensitivity (HNM), serum inflammatory mediators, and quantitative sensory testing for somatosensory hyperalgesia.

Main Results:

• Increased T2 signal ratio in the C5 brachial plexus root and C5-C8 dorsal root ganglia in WADII patients compared to HCs.
• 55% of WADII participants exhibited HNM, with associated cold/pressure hyperalgesia and increased neuropathic pain.
• Elevated serum inflammatory mediators and somatosensory changes (47% of WADII) were observed.

Conclusions:

• Acute WADII exhibits a complex phenotype with evidence of peripheral neuroinflammation in a subgroup of individuals.
• Findings suggest that neuroinflammation should be considered in WADII, necessitating a re-evaluation of current management approaches.