Diffuse axonal injury (grading)

Grading of diffuse axonal injury has been described histologically according to the anatomic distribution of injury, which correlated with outcome 1-3. The classification was first proposed by Adams in 1989 4 and divides diffuse axonal injury (DAI) into three grades:

  • grade I: involves grey-white matter interfaces
    • most commonly: parasagittal regions of frontal lobes, periventricular temporal lobes
    • less commonly: parietal and occipital lobes, internal and external capsules, and cerebellum
    • often inapparent on conventional imaging
    • may have changes on MR spectroscopy (MRS) 3
  • grade II: involves corpus callosum in addition to grade I locations
    • observed in approximately 20% of patients
    • most commonly: posterior body and splenium but does advance anteriorly with increasing severity of injury
    • most frequently unilateral
    • may be seen on SWI 3
  • grade III: involves brainstem in addition to grade I and II locations
    • most commonly: rostral midbrain, superior cerebellar peduncles, medial lemnisci and corticospinal tracts

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Article information

rID: 10020
Tag: trauma
Synonyms or Alternate Spellings:
  • Diffuse axonal injury (DAI) grading
  • Diffuse axonal injury grading
  • DAI grading

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Cases and figures

  • Case 1: grade II (GRE)
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  • Case 2: grade III (FLAIR): brainstem
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  • Case 3: grade III (T2)
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