Diffuse axonal injury (DAI)

Case contributed by Dr Ahmed Abdrabou

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

Age: 25 years
Gender: Male
CT

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. 

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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Case information

rID: 67569
Published: 12th Apr 2019
Last edited: 14th Apr 2019
Inclusion in quiz mode: Included
Institution: Ain Shams University

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