Road traffic accidents: more than just whiplash?

BMJ Case Rep. 2013 Jan 22:2013:bcr2012007832. doi: 10.1136/bcr-2012-007832.

Abstract

Following a minor road traffic accident (RTA) a 55-year-old woman developed a new onset of whole body tremor and abnormal gait. This was in the context of significant previous depressive episodes and a traumatic background relating to RTAs. After extensive investigation, no organic causes were identified. The patient was subsequently referred to psychiatry and diagnosed with conversion disorder. Subsequently, various treatments including mirtazepine, venlafaxine, clonazepam, diazepam and lithium have been tried. Currently, the patient remains on mirtazepine 15 mg nocte, diazepam 2 mg twice daily, venlafaxine 225 mg and recently has been started on lithium 400 mg nocte. The patient has also been seen regularly by a psychologist for mindfulness therapy. There has been a significant improvement after seven sessions of mindfulness therapy and the patient has long periods without a tremor and is now able to walk normally. In addition, this case highlights the importance of communication skills with our patients in diagnostic uncertainty.

Publication types

  • Case Reports

MeSH terms

  • Accidents, Traffic*
  • Antidepressive Agents / therapeutic use*
  • Drug Therapy, Combination
  • Female
  • Humans
  • Mianserin / analogs & derivatives
  • Mianserin / therapeutic use
  • Middle Aged
  • Mirtazapine
  • Sertraline / therapeutic use
  • Stress Disorders, Post-Traumatic / drug therapy
  • Stress Disorders, Post-Traumatic / etiology*
  • Whiplash Injuries / complications*
  • Whiplash Injuries / psychology

Substances

  • Antidepressive Agents
  • Mianserin
  • Mirtazapine
  • Sertraline