Neurological sequelae of minor head and neck injuries

The objective was to determine why some people who are involved in minor motor vehicle accidents, without loss of consciousness, have persisting headaches and neckache, and to suggest management of these symptoms. Between 1954 and 1994, over 4400 cases were referred for medico-legal opinions. A group has been selected for discussion. During the period 1954-1966, 414 cases following closed head injuries were seen with varying periods of post traumatic amnesia (PTA) from nil to greater than 72 h. The average time between the accident and the examination was 21 months. The shortest period was 3 months and the longest 7 years. The age at the time of the accident varied from 2.5 to 72 years. The largest group fell between the ages of 20 and 40 years. The main complaints were headache, giddiness, loss of concentration and poor memory. 380 were reviewed by questionnaire after settlement of the case. 112 cases of extension/flexion injuries of the neck were seen between 1985 and 1989 and their symptoms and resolution were compared with 50 cases seen over the same period following significant head or neck injury. The results showed that the more severe the head or neck injury, the less likely were the cases to suffer symptoms of post-traumatic headaches or persisting neck symptoms. In conclusion, while 70% of minor head and neck injuries settle within a few weeks of a motor vehicle accident, about 30% continue to complain of headaches and/or neck pain. The prolonged management, extensive physiotherapy and slow court settlement lead to excessive introspection and prolongation of symptoms.