Diffuse axonal injury | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Diffuse axonal injury

Axial susceptibility weighted image in a patient involved in a motor vehicle collision shows multiple foci of signal loss (arrows) at the gray matter/white matter junction. These regions are associated with restricted diffusion (arrows, image 2). Diffuse axonal injury is a traumatic axonal stretch injury associated with sudden deceleration. On imaging, small foci of hemorrhage may be seen at the gray matter/white matter junction.

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Susceptibility weighted images of the brain at the levels of the midbrain (image 1) and corpus callosum (image 2) in a patient with a recent motor vehicle collision show small foci of hemorrhage (arrow), consistent with diffuse axonal injury. This type of injury is a shearing injury that can result in severe neurological impairment, typically occurring at gray-white matter junctions and the corpus callosum after rapid deceleration, due to the differing specific gravities of gray and white matter.

Diffuse cortical atrophy represented by arrow, with associated white matter hypo densities of #Dementia. Found incidentally on CT after patient fell and hit #Occipital-bone while on Coumadin.

Axial FLAIR MR image of the brain in a young girl with seizures shows numerous foci of increased signal intensity (arrows) within the subcortical white matter of both cerebral hemispheres. This patient was ultimately diagnosed with acute disseminated encephalomyelitis (ADEM).

Axial CT image in an afebrile 10-year old patient with headaches and partial seizures demonstrates asymmetric and diffuse enlargement of the right cerebral hemisphere with midline shift (red arrow), decreased attenuation in the white matter, and accentuated gray-white matter differentiation. There were no signs of infection, and the primary differential was gliomatosis cerebri which was confirmed by a biopsy. Gliomatosis is an infiltrative intermediate to high grade glial tumor involving at least three contiguous lobes of the brain and has a dismal prognosis.

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