Diffuse axonal injury

Case contributed by Dr Andrew Dixon

Presentation

Motor bike accident. Reduced GCS.

Patient Data

Age: 55
Gender: Male

Day of head injury

Modality: CT

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

Patient not waking up 7 days later

Modality: MRI

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 (microhaemorrhage). Elsewhere there is evidence of less sinister traumatic injury, with right posterior and left anterior temporal lobe contusions, trace right parietal region subdural haemorrhage and trace volume subarachnoid haemorrhage with redistribution into the occipital horns of the lateral ventricles. 

Case Discussion

This case emphasises 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
Case created: 24th Jul 2015
Last edited: 1st Apr 2017
Inclusion in quiz mode: Included

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