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Diffuse axonal injury — SCE Neurology MCQ

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HardNeurorehabilitationDiffuse axonal injurySCE Neurology

A 25-year-old man remains unconscious after a high-speed road traffic collision. Initial CT head shows small punctate haemorrhages at the grey-white junction and corpus callosum with no large mass lesion. MRI susceptibility imaging shows multiple microhaemorrhages in the brainstem. What is the most likely underlying mechanism?

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Correct answer: C — Shearing injury from rotational acceleration

Shearing injury from rotational acceleration is the best answer. Deep microhaemorrhages at grey-white junction, corpus callosum and brainstem after high-energy trauma indicate diffuse axonal injury from rotational shearing. Arterial embolism produces infarction; dopamine depletion causes parkinsonism; CSF overproduction is unrelated; demyelination has inflammatory lesion patterns. Clinical pearl: MRI susceptibility sequences show traumatic microhaemorrhages better than CT.

Reference: NICE head injury guidance; neurotrauma imaging standards