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Diffuse Axonal Injury
Anne G. Osborn, MD, FACR
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22
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Diffuse axonal injury (DAI)
              • Definitions

                • Diffuse injury to axons in cerebral hemispheres, corpus callosum, brainstem ± cerebellum as result of traumatic brain injuries (TBIs)
                  • Concurrent vascular injury at capillary level
                • Traumatic microbleeds (TMBs) = small hemorrhagic lesions < 15 mm located at gray matter-white matter (GM-WM) junction and midline structures
                • TMBs as consequence of damage to vessels = indirect marker of DAI (damage to axons)

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Figueira Rodrigues et al: Early computed tomography for acute post-traumatic diffuse axonal injury: a systematic review. Neuroradiology. 62(6):653-60, 2020
                                              2. Hütter BO et al: Higher sensitivity for traumatic cerebral microbleeds at 7 T ultra-high field MRI: is it clinically significant for the acute state of the patients and later quality of life? Ther Adv Neurol Disord. 13:1756286420911295, 2020
                                              3. Jang SH: Diagnostic problems in diffuse axonal injury. Diagnostics (Basel). 10(2), 2020
                                              4. Lohani S et al: Does diffuse axonal injury MRI grade really correlate with functional outcome? World Neurosurg. 135:e424-6, 2020
                                              5. Soni N et al: Combined diffusion tensor imaging and quantitative susceptibility mapping discern discrete facets of white matter pathology post-injury in the rodent brain. Front Neurol. 11:153, 2020
                                              6. Clement MO: Imaging of brain trauma. Radiol Clin North Am. 57(4):733-44, 2019
                                              7. Hanks R et al: The relation between cognitive dysfunction and diffusion tensor imaging parameters in traumatic brain injury. Brain Inj. 33(3):355-63, 2019
                                              8. Moe HK et al: Association of cause of injury and traumatic axonal injury: a clinical MRI study of moderate and severe traumatic brain injury. J Neurosurg. 1-9, 2019
                                              9. Smith LGF et al: Advanced neuroimaging in traumatic brain injury: an overview. Neurosurg Focus. 47(6):E17, 2019
                                              10. Frey C et al: Essentials of head trauma imaging. Semin Ultrasound CT MR. 39(5):469-80, 2018
                                              11. Isokuortti H et al: Characterizing the type and location of intracranial abnormalities in mild traumatic brain injury. J Neurosurg. 129(6):1588-97, 2018
                                              12. Skalski KA et al: Hemorrhagic and non-hemorrhagic causes of signal loss on susceptibility-weighted imaging. Emerg Radiol. 25(6):691-701, 2018
                                              13. Mechtler LL et al: Advanced neuroimaging of mild traumatic brain injury. Neurol Clin. 32(1):31-58, 2014
                                              14. Liu J et al: Diffuse axonal injury after traumatic cerebral microbleeds: an evaluation of imaging techniques. Neural Regen Res. 9(12):1222-30, 2014
                                              15. Mata-Mbemba D et al: Intraventricular hemorrhage on initial computed tomography as marker of diffuse axonal injury after traumatic brain injury. J Neurotrauma. 32(5):359-65, 2014
                                              16. Moen KG et al: Traumatic axonal injury: the prognostic value of lesion load in corpus callosum, brain stem, and thalamus in different magnetic resonance imaging sequences. J Neurotrauma. 31(17):1486-96, 2014
                                              17. Perez AM et al: Longitudinal white matter changes after traumatic axonal injury. J Neurotrauma. 31(17):1478-85, 2014
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Abbreviations

                                                            • Diffuse axonal injury (DAI)
                                                          • Definitions

                                                            • Diffuse injury to axons in cerebral hemispheres, corpus callosum, brainstem ± cerebellum as result of traumatic brain injuries (TBIs)
                                                              • Concurrent vascular injury at capillary level
                                                            • Traumatic microbleeds (TMBs) = small hemorrhagic lesions < 15 mm located at gray matter-white matter (GM-WM) junction and midline structures
                                                            • TMBs as consequence of damage to vessels = indirect marker of DAI (damage to axons)

                                                          IMAGING

                                                          • General Features

                                                            • CT Findings

                                                              • MR Findings

                                                                • Nuclear Medicine Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Figueira Rodrigues et al: Early computed tomography for acute post-traumatic diffuse axonal injury: a systematic review. Neuroradiology. 62(6):653-60, 2020
                                                                                          2. Hütter BO et al: Higher sensitivity for traumatic cerebral microbleeds at 7 T ultra-high field MRI: is it clinically significant for the acute state of the patients and later quality of life? Ther Adv Neurol Disord. 13:1756286420911295, 2020
                                                                                          3. Jang SH: Diagnostic problems in diffuse axonal injury. Diagnostics (Basel). 10(2), 2020
                                                                                          4. Lohani S et al: Does diffuse axonal injury MRI grade really correlate with functional outcome? World Neurosurg. 135:e424-6, 2020
                                                                                          5. Soni N et al: Combined diffusion tensor imaging and quantitative susceptibility mapping discern discrete facets of white matter pathology post-injury in the rodent brain. Front Neurol. 11:153, 2020
                                                                                          6. Clement MO: Imaging of brain trauma. Radiol Clin North Am. 57(4):733-44, 2019
                                                                                          7. Hanks R et al: The relation between cognitive dysfunction and diffusion tensor imaging parameters in traumatic brain injury. Brain Inj. 33(3):355-63, 2019
                                                                                          8. Moe HK et al: Association of cause of injury and traumatic axonal injury: a clinical MRI study of moderate and severe traumatic brain injury. J Neurosurg. 1-9, 2019
                                                                                          9. Smith LGF et al: Advanced neuroimaging in traumatic brain injury: an overview. Neurosurg Focus. 47(6):E17, 2019
                                                                                          10. Frey C et al: Essentials of head trauma imaging. Semin Ultrasound CT MR. 39(5):469-80, 2018
                                                                                          11. Isokuortti H et al: Characterizing the type and location of intracranial abnormalities in mild traumatic brain injury. J Neurosurg. 129(6):1588-97, 2018
                                                                                          12. Skalski KA et al: Hemorrhagic and non-hemorrhagic causes of signal loss on susceptibility-weighted imaging. Emerg Radiol. 25(6):691-701, 2018
                                                                                          13. Mechtler LL et al: Advanced neuroimaging of mild traumatic brain injury. Neurol Clin. 32(1):31-58, 2014
                                                                                          14. Liu J et al: Diffuse axonal injury after traumatic cerebral microbleeds: an evaluation of imaging techniques. Neural Regen Res. 9(12):1222-30, 2014
                                                                                          15. Mata-Mbemba D et al: Intraventricular hemorrhage on initial computed tomography as marker of diffuse axonal injury after traumatic brain injury. J Neurotrauma. 32(5):359-65, 2014
                                                                                          16. Moen KG et al: Traumatic axonal injury: the prognostic value of lesion load in corpus callosum, brain stem, and thalamus in different magnetic resonance imaging sequences. J Neurotrauma. 31(17):1486-96, 2014
                                                                                          17. Perez AM et al: Longitudinal white matter changes after traumatic axonal injury. J Neurotrauma. 31(17):1478-85, 2014