Diffuse axonal injury

Case contributed by Assoc Prof Frank Gaillard


High speed motor vehicle accident. GCS 6 at the scene. Brought into the Emergency Department intubated.

Patient Data

Age: 20 years
Gender: Male

Extensive grey-white matter junction regions of abnormality are present, appearing both as petechial hemorrhages and hypodense foci.  There is a left anterior temporal pole hemorrhagic contusion, and subarachnoid hemorrhage within the left Sylvian fissure and the sulci of both hemispheres. 

Ventricles and basal cisterns are age appropriate. 


CT brain obtained 5 days later

CT obtained 5 days later demonstrates increasing cerebral edema with severe uncal and tonsillar herniation. Loss of grey white matter differentiation is present in the temporal lobes likely to represent infarction. Numerous hemorrhages are again visible, a little more conspicuous than on the acute scan, many seen at the grey matter junction. Subarachnoid and thin tentorial subdural hemorrhages are also seen. 

Annotated image

Numerous traumatic injuries are demonstrated, including a left temporal pole contusion (green dotted line), hemorrhagic (red) and non-hemorrhagic (blue) grey-white matter junction focal lesions of diffuse axonal injury and traumatic subarachnoid blood (yellow). 

On the subsequent scan, marked swelling and cerebellar tonsillar herniation has developed with the cerebellar tonsils ( * ) embracing and compressing the medulla (orange). 

Case Discussion

Cerebral swelling in the setting of closed head injuries is a major source of secondary injury and is challenging to manage. This patient passed away shortly after the second CT scan. 

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Case information

rID: 19209
Published: 16th Aug 2012
Last edited: 16th Jan 2021
Inclusion in quiz mode: Included