A case-control study of cerebellar tonsillar ectopia (Chiari) and head/neck trauma (whiplash)

Michael D. Freeman, Scott Rosa, David Harshfield, Francis Smith, Robert Bennett, Christopher J. Centeno, Ezriel Kornel, Ake Nystrom, Dan Heffez, Sean S. Kohles

    Research output: Contribution to journalArticlepeer-review

    22 Scopus citations


    Primary objective: Chiari malformation is defined as herniation of the cerebellar tonsils through the foramen magnum, also known as cerebellar tonsillar ectopia (CTE). CTE may become symptomatic following whiplash trauma. The purpose of the present study was to assess the frequency of CTE in traumatic vs non-traumatic populations. Study design: Case-control. Methods and procedures: Cervical MRI scans for 1200 neck pain patients were reviewed; 600 trauma (cases) and 600 non-trauma (controls). Half of the groups were scanned in a recumbent position and half were scanned in an upright position. Two radiologists interpreted the scans for the level of the cerebellar tonsils. Main outcomes and results: A total of 1195 of 1200 scans were read. CTE was found in 5.7% and 5.3% in the recumbent and upright non-trauma groups vs 9.8% and 23.3% in the recumbent and upright trauma groups (p=0.0001). Conclusions: The results described in the present investigation are first to demonstrate a neuroradiographic difference between neck pain patients with and without a recent history of whiplash trauma. The results of prior research on psychosocial causes of chronic pain following whiplash are likely confounded because of a failure to account for a possible neuropathologic basis for the symptoms.

    Original languageEnglish (US)
    Pages (from-to)988-994
    Number of pages7
    JournalBrain Injury
    Issue number7-8
    StatePublished - Jul 2010


    • Cerebellar tonsillar ectopia
    • Chiari
    • Upright MRI
    • Whiplash trauma

    ASJC Scopus subject areas

    • Neuroscience (miscellaneous)
    • Developmental and Educational Psychology
    • Clinical Neurology


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