Diffuse axonal hemorrhage - grade III

Case contributed by Dr Mostafa El-Feky

Presentation

Fall from 4th floor 7 months ago. Alleged history of intracranial hemorrhage.

Patient Data

Age: 20 years
Gender: Male

Brain - current

mri

Multiple foci of SWI blooming artifact all over the brain parenchyma, with no brain changes at other MRI sequences. SWI-bloomed areas are also noted at right side body and splenium of corpus callosum as well as the rostral midbrain, reflecting hemorrhagic diffuse axonal injury (DAI) grade III.

No extra-axial collections detected.

Hippocampal sulcus remnant cysts are noted.

Pelvis - 2 months ago

x_ray

Old malunited fracture of left pubic bone with 2ry symphysis pubic arthropathy.

Left foot - 2 months ago

x_ray

Healing fracture of left calcaneous associated with calcaneal flattening and marked bony sclerosis. Secondary pes planus is noted.

Case Discussion

Brain changes are consistent with old grade III hemorrhagic diffuse axonal injury (DAI), in a polytrauma patient. Microhaemorrhagic foci are noted involving different parts of brain parenchyma, corpus callosum and brainstem. Blooming artifact on SWI is most sensitive for detection of foci of microhemorrhage. 

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