Chronic Trauma with Diffuse Axonal Injury-MRI

During the chronic stage of traumatic brain injury, T2*-weighted gradient-echo imaging at high field strength is superior to T1- and T2-weighted MR imaging in the detection of lesions suspicious of diffuse axonal injury. Based on the signal intensity characteristics on T2*-weighted gradient-echo images, most of these lesions are hemorrhagic.

 This is young male patient with old history of RTA and persitent vegetative state. GRE images shows punctate blood products in the bifrontal and left temporal white matter. Focal bleed is also noted in the rostral midbrain and superior cerebellar peduncle, along with cerebellum. Findings in his clinical setting are consistent with diffuse axonal injury.

Diffuse Axonal Injury-MRI

Diffuse axonal injury (DAI) is a frequent result of traumatic deceleration injuries and a frequent cause of persistent vegetative state in patients. DAI typically consists of several focal white-matter lesions measuring 1-15 mm in a characteristic distribution. The most common MRI finding is the presence of multifocal areas of abnormal signal (bright on T2-weighted images) at the white matter in the temporal or parietal corticomedullary junction or in the splenium of the corpus callosum.