0:01

Normally, we start with the CT scan

0:04

and then show the MRI findings.

0:06

This is the same case as the previous, uh, example that

0:10

I showed in a patient who has diffuse axonal injury.

0:14

In this case, I'm going to show the CT findings.

0:17

So the CT findings include the increased density

0:21

along the tentorium, which is likely secondary

0:23

to blood products layering along the tentorium.

0:27

Which was also seen on the susceptibility-weighted scans.

0:30

But in addition, we see this focal area of hyperdensity

0:34

in the splenium of the corpus callosum with its junction,

0:37

with the septum pellucidum, as well as blood products

0:43

in the occipital horns of the lateral ventricles.

0:46

So for the residents out there,

0:48

here is a useful pearl.

0:50

If you see in a patient who has had trauma,

0:54

hemorrhage layering in the occipital

0:56

horns of the lateral ventricles, and

0:58

you see no other evidence of trauma,

1:03

this is more than likely secondary to splenium

1:07

traumatic injury that is not seen on the

1:10

CT but will be evident on the MRI scan.

1:13

And by virtue of being a splenium tear,

1:16

it's going to be a significant grade 2

1:21

diffuse axonal injury.

1:22

So to repeat, if you're just seeing a

1:25

little bit of hemorrhage layering in

1:26

the occipital horns, do not dismiss it.

1:29

It likely is secondary to a shearing injury of the

1:33

splenium, which indicates diffuse axonal injury.

1:36

In this case, we do see the hemorrhage in the

1:39

splenium, but sometimes you don't see anything at all.

1:43

So here, occipital horn hemorrhage

1:47

associated with hemorrhagic splenium.

1:50

Diffuse axonal injury.

1:52

Note that superiorly, we get just a little

1:56

sense of potentially some blood products in the

1:59

subarachnoid space and potentially in the parenchyma.

2:04

A petechial hemorrhage.

2:05

Again, this doesn't look that severe, but on the MRI

2:08

scan, what we saw was that the FLAIR had diffuse

2:11

subarachnoid hemorrhage throughout, as well as

2:16

multiple foci of hemorrhage at the gray-white

2:19

junction, as well as the tear in the splenium

2:24

with hemorrhage, as well as the midbrain

2:28

hemorrhage and edema, which is not evident on CT.

2:33

What does the CT get us? A little bit

2:35

better sense of blood products layering

2:37

along the tentorium in this specific case.

2:40

So the combination of CT with MRI scanning

2:43

is useful for prognostication—

2:47

whether the patient will do well or not so well,

2:50

depending upon the grade of diffuse

2:53

axonal injury in traumatic brain injury.

Case: DAI on CT

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