Intermediary injury

Discussion:

Intermediary injuries are shearing hemorrhagic contusions from disruption of the lenticulostriate injuries affecting the basal ganglia or thalami. They are associated with diffuse axonal injury (DAI), which is almost certain in this case.

This case illustrates that the initial CT brain can have a collection of apparently minor/subtle injuries that evolve into more severe injuries. Also, DAI can often be occult or under called on CT. It should be remembered that CT provides only a "snapshot" in time. 

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