Diffuse axonal injury

Case contributed by Dr Bruno Di Muzio


Pedestrian vs. car accident. Prolonged ventilation requirements due to poor neurology recovery.

Patient Data

Age: 40
Gender: Male

CT Brain (admission)

No acute cranial haemorrhage. No intra or extra-axial mass or collection. No hydrocephalus. Calcification in the right 4th ventricle is most likely to incidentally represent further choroid calcification. No calvarial, base of skull or facial bone fracture.


CT Brain (5 days later)

No intracranial haemorrhage. There are a few ill-defined tiny areas of white matter hypoattenuation scattered through both cerebral hemispheres, which were not evident on the previous imaging. The grey-white matter differentiation is preserved. Ventricular system and cisternal spaces appear normal. Fourth ventricle likely choroid calcification. The visualised orbits, paranasal sinuses, mastoid air cells, and calvaria appear unremarkable.

Conclusion: A few brain parenchyma hypodense foci are, in this clinical scenario, suspicious for diffuse axonal injuries that have become more evident. 


MRI Brain (trauma protocol)

There are numerous widespread punctate susceptibility artefacts scattered throughout the supratentorial brain, including the grey white junction and corpus callosum. Some of these foci are associated with parenchymal T2/FLAIR hyperintensities and diffusion restriction, in particular along the hemisphere subcortical and periventricular white matter and within the corpus callosum. Distribution is typical of shear injury. In the posterior fossa, the susceptibility foci are present, if less obvious than the easily visualised associated foci of diffusion restriction and T2 signal change in the right pons, bilateral cerebellar peduncles and in the cerebellar hemispheres Ventricular system and cisternal spaces appear normal. There is bilateral mastoid fluid, and sphenoid sinus mucosal thickening. The visualised orbits and calvaria appear unremarkable.

Case Discussion

 The imaging features are consistent with diffuse axonal injury (high grade).

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Case information

rID: 57697
Case created: 7th Jan 2018
Last edited: 8th Mar 2018
Inclusion in quiz mode: Excluded

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