A 39-year-old female polytrauma patient is admitted to intensive trauma unit with reduced consciousness. The referring team would like some neuroimaging as they suspect diffuse axonal injury (DAI). Which of the following is true regarding DAI? 1. DAI patients usually have an abnormal CT head 2. DAI patients typically have a 'starry sky' appearance on gradient echo sequences 3. The thalamus is typically effected 4. There is sparing of the grey-white matter junction 5. Patient's can recover with no major neurological sequelae
1. FALSE - Patients can and often have a normal CT head 2. FALSE - This is the typical description for cerebral fat embolism 3. FALSE - The thalamus and basal ganglia are typically not effected; seeing haemorrhage here should make you think of hypertensive disease 4. FALSE - The grey-white matter junction is typically involved and may be the only site of involvement in grade I disease. 5. TRUE - DAI is a spectrum with grade I cases often making full recovery whilst grade III often have far worse outcomes.
Extensive fine microhemorrhages throughout the cerebral hemispheres and cerebellum with specific conglomeration at the grey-white matter interface, splenium of the corpus callosum and upper brainstem in keeping with a grade III diffuse axonal injury which is important for prognostication.