eMedicine Specialties > Radiology > Brain/Spine

Diffuse Axonal Injury: Follow-up

Author: Jeffrey R Wasserman, DO, Staff Physician, Department of Diagnostic Radiology, Medical College of Pennsylvania-Hahnemann University Hospital
Coauthor(s): Robert A Koenigsberg, DO, MSc, FAOCR, Director of Neuroradiology, Professor, Department of Radiology, Drexel University College of Medicine
Contributor Information and Disclosures

Updated: Jul 26, 2007

Intervention

Medicolegal Pitfalls

  • False negatives are common with CT scans. In fact, CT-scan findings frequently are normal or almost normal on initial presentation (see Image 5). For this reason, when CT-scan findings are negative and DAI is suggested clinically, MRI may be performed, since this modality can demonstrate lesions not observed through CT scanning.
  • False negatives may occur with MRI if only routine sequences are performed. A sequence (such as gradient echo) that accentuates the susceptibility artifact arising from blood products must be performed in order to recognize small petechial hemorrhages.
 


More on Diffuse Axonal Injury

Overview: Diffuse Axonal Injury
Imaging: Diffuse Axonal Injury
Follow-up: Diffuse Axonal Injury
Multimedia: Diffuse Axonal Injury
References
[ CLOSE WINDOW ]

References

  1. Holbourn AHS. Mechanics of head injuries. Lancet. 1943;2:438-41.

  2. Wang H, Duan G, Zhang J, et al. Clinical studies on diffuse axonal injury in patients with severe closed head injury. Chin Med J (Engl). Jan 1998;111(1):59-62. [Medline].

  3. Teasdale GM. Head injury. J Neurol Neurosurg Psychiatry. May 1995;58(5):526-39. [Medline].

  4. Adams JH, Jennett B, McLellan DR, et al. The neuropathology of the vegetative state after head injury. J Clin Pathol. Nov 1999;52(11):804-6. [Medline]. [Full Text].

  5. Atlas SW, ed. Magnetic Resonance Imaging of the Brain and Spine. 2nd ed. New York, NY: Raven Press; 1996.

  6. Gean AD. Imaging of Head Trauma. New York, NY: Raven Press; 1994.

  7. Gentry LR, Godersky JC, Thompson B. MR imaging of head trauma: review of the distribution and radiopathologic features of traumatic lesions. AJR Am J Roentgenol. Mar 1988;150(3):663-72. [Medline].

  8. Gentry LR, Godersky JC, Thompson B, et al. Prospective comparative study of intermediate-field MR and CT in the evaluation of closed head trauma. AJR Am J Roentgenol. Mar 1988;150(3):673-82. [Medline].

  9. Gieron MA, Korthals JK, Riggs CD. Diffuse axonal injury without direct head trauma and with delayed onset of coma. Pediatr Neurol. Nov 1998;19(5):382-4. [Medline].

  10. Gleckman AM, Bell MD, Evans RJ, et al. Diffuse axonal injury in infants with nonaccidental craniocerebral trauma: enhanced detection by beta-amyloid precursor protein immunohistochemical staining. Arch Pathol Lab Med. Feb 1999;123(2):146-51. [Medline].

  11. Ito H, Ishii K, Onuma T, et al. Cerebral perfusion changes in traumatic diffuse brain injury; IMP SPECT studies. Ann Nucl Med. May 1997;11(2):167-72. [Medline].

  12. McGowan JC, McCormack TM, Grossman RI, et al. Diffuse axonal pathology detected with magnetization transfer imaging following brain injury in the pig. Magn Reson Med. Apr 1999;41(4):727-33. [Medline].

  13. Ommaya AK, Gennarelli TA. Cerebral concussion and traumatic unconsciousness. Correlation of experimental and clinical observations of blunt head injuries. Brain. Dec 1974;97(4):633-54. [Medline].

  14. Osborn AG. Diagnostic Neuroradiology. St Louis, Mo: Mosby-Year Book; 1994:212-5.

  15. Wilson JT, Hadley DM, Wiedmann KD, et al. Neuropsychological consequences of two patterns of brain damage shown by MRI in survivors of severe head injury. J Neurol Neurosurg Psychiatry. Sep 1995;59(3):328-31. [Medline].

  16. Yamamoto T, Koeda T, Ishii S, et al. A patient with cerebral palsy whose mother had a traffic accident during pregnancy: a diffuse axonal injury?. Brain Dev. Jul 1999;21(5):334-6. [Medline].

  17. Okamoto T, Hashimoto K, Aoki S, et al. Cerebral blood flow in patients with diffuse axonal injury--examination of the easy Z-score imaging system utility. Eur J Neurol. May 2007;14(5):540-7. [Medline].

  18. de la Plata CM, Ardelean A, Koovakkattu D, et al. Magnetic resonance imaging of diffuse axonal injury: quantitative assessment of white matter lesion volume. J Neurotrauma. Apr 2007;24(4):591-8. [Medline].

  19. Zheng WB, Liu GR, Li LP, et al. Prediction of recovery from a post-traumatic coma state by diffusion-weighted imaging (DWI) in patients with diffuse axonal injury. Neuroradiology. Mar 2007;49(3):271-9. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

DAI, axonal shear injury, axonal shear-strain injury, traumatic brain injuries

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Jeffrey R Wasserman, DO, Staff Physician, Department of Diagnostic Radiology, Medical College of Pennsylvania-Hahnemann University Hospital
Jeffrey R Wasserman, DO is a member of the following medical societies: American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Koenigsberg, DO, MSc, FAOCR, Director of Neuroradiology, Professor, Department of Radiology, Drexel University College of Medicine
Robert A Koenigsberg, DO, MSc, FAOCR is a member of the following medical societies: American Osteopathic Association, American Society of Interventional & Therapeutic Neuroradiology, American Society of Neuroradiology, and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey L Creasy, MD, Associate Professor, Associate Section Head, Division of Neuroradiology, Director, Neuroradiology Fellowship, Department of Radiology, Vanderbilt University
Jeffrey L Creasy, MD is a member of the following medical societies: American College of Radiology, American Society of Neuroradiology, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Robert L DeLaPaz, MD, Director, Professor, Department of Radiology, Division of Neuroradiology, Columbia University
Robert L DeLaPaz, MD is a member of the following medical societies: American Society of Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

James G Smirniotopoulos, MD, Professor of Radiology, Neurology, and Biomedical Informatics, Chairman, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences
James G Smirniotopoulos, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Head and Neck Radiology, American Society of Neuroradiology, American Society of Pediatric Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.