Diffuse axonal injury: a case report and MRI findings

Vo, Duc Tan; Phan, Chien Cong; Le, Hy Gia Nguyen; Vo, Truc Phuong; Thi, Uyen Tu; Le, Hang Kim; Ha, Tram Bich Thi

doi:10.1016/j.radcr.2021.10.006

Cited by 9 publications

(8 citation statements)

References 11 publications

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“…The overlap in imaging findings between diffuse axonal injury (DAI) and CFES with NCWMH may present a diagnostic dilemma. The lesions seen on MRI are not unique to CFES [ 34 ] and can also be seen with DAI [ 35 ]. DAI presents with a variety of MRI findings, which can include hypointense microbleeds as well as hyperintensities (NCWMH).…”

Section: Discussionmentioning

confidence: 99%

Occurrence of Numerous Cerebral White Matter Hyperintensities in Trauma Patients With Cerebral Fat Embolism: A Systematic Review and Report of Two Cases

Huang,

Dunham,

Chance

2023

Cureus

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There has been little effort to identify an overall occurrence of numerous cerebral white matter hyperintensities (NCWMH) on relevant brain magnetic resonance imaging (MRI) sequences in postinjury cerebral fat embolism syndrome (CFES) patients. Also, quantification of pre-CFES cognitive status, degree of neurologic deterioration, and presence of a skeletal fracture with CFES is nominal. The authors performed a PubMed search and identified 24 relevant manuscripts. Two case reports from the authors’ institution were also used. The presence of NCWMH was assessed by reviewing T2-weighted image (T2WI), diffusion-weighted image (DWI), fluid-attenuated inversion recovery (FLAIR) figures and captions, and by evaluating manuscript descriptions. When pre-CFES cognitive status was described, it was categorized as Glasgow Coma Scale (GCS) score = 14-15 (yes or no). When the degree of neurologic deterioration was noted with CFES, it was classified as coma or GCS ≤ 8 (yes or no). When skeletal fractures were itemized, they were categorized as yes or no. The total number of CFES patients was 133 (literature search was 131 and two author-described case reports). Of the 131 patients with manuscript MRI figures or descriptive statements, 120 (91. 6%) had NCWMH. Of 63 patients with a delineation of the MRI sequence, NCWMH appeared on DWI in 24, on T2WI in 57, and on FLAIR in 10 patients. Pre-CFES cognitive status was GCS 14-15 in 93.5% (58/62) of the patients. The CFES neurologic deterioration was coma or GCS ≤ 8 in 52.5% (62/118) of the patients. A skeletal fracture was present in 99.0% (101/102) of the CFES patients. The presence of NCWMH in trauma patients with hospital-acquired neurologic deterioration and the presence of a skeletal fracture is consistent with CFES.

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Section: Discussionmentioning

confidence: 99%

Occurrence of Numerous Cerebral White Matter Hyperintensities in Trauma Patients With Cerebral Fat Embolism: A Systematic Review and Report of Two Cases

Huang,

Dunham,

Chance

2023

Cureus

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“…Microhemorrhage in subcortical white matter can be seen in conditions like diffuse axonal injury (DAI), trauma-related fat embolism, and cerebral amyloid angiopathy (CAA) in elderly patients [ 11 , 12 ]. Accurate diagnosis requires ruling out trauma, considering clinical context, and investigating the patient's medical history and physical examination for insights into the underlying cause [13] .…”

Section: Discussionmentioning

confidence: 99%

Susceptibility - weighted imaging: A valuable diagnostic tool for early detection of high-altitude cerebral edema: A case report

Kandel

Regmi

Poudel

2023

Radiology Case Reports

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“…In 2017, Hamdeh et al [ 13 ] proposed an extended classification of the typical three-grade system based on the observation that TAI lesions in the substantia nigra and the tegmentum were independent risk factors for poor outcome and hence represented a distinct fourth grade. Except for the conventional MRI sequences, other MRI sequences such as susceptibility-weighted imaging (SWI), diffusion-weighted imaging (DWI), and diffusion tensor imaging (DTI) have substantially improved the diagnostic sensitivity of MRI to detect TAI lesions [ 24 ].…”

Section: Imagingmentioning

confidence: 99%

The Role of Novel Imaging and Biofluid Biomarkers in Traumatic Axonal Injury: An Updated Review

Lampros,

Vlachos,

Tsitsopoulos

et al. 2023

Biomedicines

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Traumatic brain injury (TBI) is a leading cause of disability worldwide. Traumatic axonal injury (TAI) is a subtype of TBI resulting from high-impact forces that cause shearing and/or stretching of the axonal fibers in white matter tracts. It is present in almost half of cases of severe TBI and frequently associated with poor functional outcomes. Axonal injury results from axonotomy due to mechanical forces and the activation of a biochemical cascade that induces the activation of proteases. It occurs at a cellular level; hence, conventional imaging modalities often fail to display TAI lesions. However, the advent of novel imaging modalities, such as functional magnetic resonance imaging and fiber tractography, has significantly improved the detection and characteristics of TAI. Furthermore, the significance of several fluid and structural biomarkers has also been researched, while the contribution of omics in the detection of novel biomarkers is currently under investigation. In the present review, we discuss the role of imaging modalities and potential biomarkers in diagnosing, classifying, and predicting the outcome in patients with TAI.

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Diffuse axonal injury: a case report and MRI findings

Cited by 9 publications

References 11 publications

Occurrence of Numerous Cerebral White Matter Hyperintensities in Trauma Patients With Cerebral Fat Embolism: A Systematic Review and Report of Two Cases

Occurrence of Numerous Cerebral White Matter Hyperintensities in Trauma Patients With Cerebral Fat Embolism: A Systematic Review and Report of Two Cases

Susceptibility - weighted imaging: A valuable diagnostic tool for early detection of high-altitude cerebral edema: A case report

The Role of Novel Imaging and Biofluid Biomarkers in Traumatic Axonal Injury: An Updated Review

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