Diffuse axonal injury with bilateral hypertrophic olivary degeneration
Presentation
Deterioration of the level of consciousness initiated by road traffic accidents six months ago.
Patient Data
Diffuse brain atrophic changes with multiple brain parenchymal T2 hyperintense foci in the subcortical white matter and T2 hypointense foci in the left cerebral crus and the splenium of the corpus callosum. Gradient echo sequence reveals multiple areas of blooming in the brain stem, right cerebral peduncle and the cerebral sub-cortical areas, consistent with prior grade 3 diffuse axonal injury.
Bilateral increase in signal intensity of the inferior olivary nucleus in the T2/FLAIR sequences with nucleus swelling more pronounced on the left side. This is consistent with bilateral hypertrophic olivary degeneration.
Case Discussion
The case reflects the importance of the gradient echo sequence in detecting otherwise easily missed findings that explains the worsening of the patient's clinical status.