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Grading of diffuse axonal injury

Grading of diffuse axonal injury has been described histologically according to the anatomic distribution of injury, which correlated with outcome 1-3. The classification was first proposed by Adams in 1989 4 and divides diffuse axonal injury (DAI) into three grades:

  • grade I : involves grey-white matter interfaces
    • most commonly : parasagittal regions of frontal lobes, periventricular temporal lobes
    • less commonly : parietal and occipital lobes, internal and external capsules, and cerebellum
    • often inapparent on conventional imaging
    • may have changes on MRS 3
  • grade II : involves corpus callosum in addition to stage I locations
    • observed in approximately 20% of patients
    • most commonly : posterior body and splenium but does advance anteriorly with increasing severity of injury
    • most frequently unilateral
    • may be seen on SWI 3
  • grade III : involves brainstem in addition to stage I and II locations
    • most commonly : rostral midbrain, superior cerebellar peduncles, medial lemnisci and corticospinal tracts

See also

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