Cervical Trauma and Tremor

This report¹ by a British neurologist details the findings from six cases of patients who developed movement disorders after motor vehicle-induced cervical trauma. The following case�Case 2—is particularly interesting:

"A 24-year old secretary was sitting in her stationary car when it was hit from behind. She was thrown forwards, restrained by her seat belt, and hit the back of her head against the head rest. Within an hour she had developed a pain in the neck radiating into both arms, associated with paraesthesiae in both arms, but predominantly in the right C5 and C6 distribution. Two weeks after the trauma she developed a tremor in her right hand, particularly on performing activities. She could no longer carry a full cup of coffee and had difficulty holding pen or paper. The neck pain settled to become only intermittent, but the tremor persists 12 months after the accident. Before the trauma she had a very minor tremor, of a different character, present in both hands when under stress.

"Examination showed mild restriction of neck movements by pain and spasm in the trapeziae, worse on the right. Tone in the limbs was normal. There was slight weakness of hand grip and opponens pollicis on the right. Pin prick sensation was reduced in a C6 distribution in the hand. There was a 6-8 Hz action type tremor, particularly present when the right wrist was extended or flexed and also when the thumb was flexed.

"Plain cervical spine radiography showed loss of the normal curvature and MRI of the spine was normal."

The C6 distribution of symptoms is interesting, as most of the recent studies on whiplash show that this area of the cervical spine is most susceptible to trauma.

The author reported evidence of nerve root damage or spinal cord involvement in 4 of the six cases. Also, five of the six cases in this report were women, who are more likely to suffer from whiplash injury then men:

"Idiopathic torsion dystonia and peripheral induced dystonia are reported to have a female preponderance²...This may reflect the higher incidence of joint laxity in the female population³ with a greater degree of flexion extension resulting from this type of injury."

The author also refers to Jankovic,² who suggested criteria for determining whether movement disorders are trauma-related or not. These are:

Injury must have been severe enough to cause local symptoms for two weeks.
The onset of the movement disorder should be within a year of the injury.
The movement disorder must have an anatomical association with the site of the injury.

Ellis SJ. Tremor and other movement disorders after whiplash type injuries. Journal of Neurology, Neurosurgery, and Psychiatry 1997;63:110-112.
Jankovic J. Post-traumatic movement disorders: central and peripheral mechanisms. Neurology 1994;44:2006-14.
Larsson LG, Baum J, Muholkar GS. Hypermobility: features and differential incidence between the sexes. Arthritis & Rheumatism 1987;30:1426-1430.

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