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Diffuse axonal injury

Case contributed by Hidayatullah Hamidi
Diagnosis certain

Presentation

History of closed brain injury due to road traffic accident 15 days ago. Unconscious status for last 10 days.

Patient Data

Age: 10 years
Gender: Male
ct

Multiple hemorrhagic lesions are seen in gray white matter junction of bilateral cerebral hemispheres. The larger lesions are surrounded by significant edema.

mri

Multiple hemorrhagic lesions (high on T1WI with blooming artifact on GRE) in bilateral frontal lobes white matter, gray-white matter junction of bilateral cerebral hemispheres as well as in the splenium of carpus callosum. Brain stem is unremarkable. The features are representing diffuse axonal injury (grade II).

Laminar T1WI high signal intensities in bilateral fronto-pareital gyri suggestive of cortical laminar necrosis probably due to hypoxia.

Case Discussion

Diffuse axonal injury is a severe form of traumatic brain injury caused by shearing forces. CT may fail to diagnose when the lesions are non-hemorrhagic while MRI has a significant rule in diagnosis.

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