A Pediatric Radiology Textbook and Pediatric Radiology Digital Library
Pediatric Diffuse Axonal Injury
Etiology: — Acceleration or deceleration injury — Hemorrhagic or non-hemorrhagic shearing injury — Pathologically initial post traumatic damage to axons of brain is incomplete with subsequent swelling of cerebral tissue leading to axon dissection
Imaging: — Lesions often hemorrhagic — Common locations – gray matter white matter junction and corpus callosum and fornix and internal capsule and deep gray matter and cerebellar folia dorsal to dentate nuclei, dorsolateral brainstem and cerebellar peduncle
Imaging CT: — Is insensitive to extent of diffuse axonal injury — Often there is a discrepancy between initial clinical picture and CT findings
Imaging MRI: — SWI and DWI: Very sensitive to extent of diffuse axonal injury — GRE and FLAIR: Sensitive to diffuse axonal injury
DDX:
Complications:
Treatment:
Clinical: — 50% of patients with traumatic acceleration deceleration injury to head suffer diffuse axonal injury — Loss of consciousness following injury — Very low score on Glasgow coma scale
Radiology Cases of Diffuse Axonal Injury
Axial CT without contrast of the brain shows multiple high density punctate intraparenchymal lesions at the gray matter-white matter junction in the bilateral cerebral hemispheres.Axial CT without contrast of the brain obtained initially (left) shows loss of delineation of the cortical sulci and ventricular system. Axial CT without contrast obtained two days later (right) now also shows a round focus of hyperdensity at the right parietal gray matter white matter junction.
