Diffuse axonal injury

Case contributed by Dr Andrew Dixon

Presentation

Motor bike accident. Reduced GCS.

Patient Data

Age: 55
Gender: Male
CT

Day of head injury

Left parietal scalp hematoma. Trace to small volume traumatic sulcal subarachnoid hemorrhage bilaterally. Subtle suggestion of contusion within the posterior portion of the right temporal lobe. 

MRI

Not waking up on Day 7

MRI reveals features of grade 3 diffuse axonal injury with small T2 hyperintense, diffusion restricting foci at the bilateral frontal grey-white junctions, within the corpus callosum (including the splenium) and within the dorsal midbrain / superior cerebellar peduncles bilaterally. Subtle low signal blooming is appreciable on the gradient sequence at some of these locations (microhemorrhage). Elsewhere there is evidence of less sinister traumatic injury, with right posterior and left anterior temporal lobe contusions, trace right parietal region subdural hemorrhage and trace volume subarachnoid hemorrhage with redistribution into the occipital horns of the lateral ventricles. 

Case Discussion

This case emphasizes how traumatic shearing injury to the brain (diffuse axonal injury) can be invisible on initial CT but is far more easily detected on MRI. The three typical sites of involvement which correlate with severity are shown in this case; the cortical grey-white interface (grade 1), the corpus callosum (grade 2) and brainstem/superior cerebellar peduncles (grade 3).  

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Case information

rID: 38553
Published: 24th Jul 2015
Last edited: 16th Oct 2019
Inclusion in quiz mode: Included

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