Presentation
The patient was admitted to the emergency department following severe road traffic injury. His Glasgow Coma Scale (GCS) was 5 though he was intubated.
Patient Data
Punctate hyperdense hemorrhage foci are noted at the right temporal lobe as well as the brain stem. The discrepancy between CT findings and the patient's general condition mandates further investigation by MRI.
Right fronto-temporal cortical and subcortical altered signal intensity displaying bright T2/FLAIR signal indicating non-hemorrhagic contusion. Similar but smaller areas are noted on left occipital, left temporal and dorsal aspect of brainstem. Moreover, there is edema of the corpus callosum.
Multiple punctate foci of diffusion restriction are noted at the grey-white matter junction of both cerebral hemispheres, some of them display blooming on T2*, denoting petechial hemorrhage.
Case Discussion
Grey-white matter junction, corpus callosum and dorsal aspect of the brainstem are common sites for diffuse axonal injury. The case illustrates findings consistent with grade III diffuse axonal injury. Unfortunately, the patient died few days after this scan.
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