A case of vertigo following a traffic accident with subsequent psychiatric symptoms

Abstract

In January 2005, a 31-year-old woman experienced a traffic accident in which her car was struck from behind. With generalized rigidity and vertigo, she was admitted to the orthopedics department of a hospital. Her chief complaints included persistent numbness in all four limbs, a sensation of darkness before the eyes, and occasional bilateral tinnitus. She attempted suicide by slitting her wrists to escape from her severe vertigo, and visited a psychiatric hospital for treatment of the vertigo in April 2005, but treatment failed. She was referred to our department in July 2005. The vertigo was rotatory and non-rotatory and intensified in the period from the evening to night. The patient presented with difficulty in opening her eyes and astasia, as a result of which examination for findings such as nystagmus could not be completed. It was unclear whether these symptoms were attributable to the vertigo or a psychiatric disorder. Caloric testing revealed a right-left difference, which improved over 2 years. The causes of the vertigo were left vestibular dysfunction, somatoform disorder, and atlantoaxial subluxation. In the present case, since the patient was unable to open her eyes and exhibited compulsive symptoms on examination, we considered it difficult to support her coping, so instead we attempted to listen to and be sympathetic with the patient and provide appropriate information and adequate physical care. However, exchange of information among the 7 departments that examined the patient proved inadequate, resulting in failure in determination of diagnosis/treatment strategies and appropriate provision of information to the patient. After the Medical Certificate of Sequelae of a Traffic Accident has been prepared, all medical expenses must be covered by the patient. Establishment of a system in which the Identification Booklet for Physically Disabled People can be issued immediately after a Medical Certificate of Sequelae has been prepared should be considered.