Diffuse Axonal Injury(DAI) is a brain injury, in which damage in the form of extensive lesions in white matter tracts occur over a widespread area. DAI is one of the most common and devastating types of traumatic brain injury. It is a major cause of unconsciousness and persistent vegetative state after head trauma. The outcome is frequently coma with over 90% of patients with severe DAI never regaining consciousness. Those who wake up remain significantly impaired.
5year old male child was brought to the emergency room with history of motor vehicle accident with loss of consciousness and irregular respirations. He had a generalized tonic clonic convulsion in the ER. His Glasgow coma scale was 5/15.Pupils were dialated but reacting to light.
He was electively intubated in view of the low Glasgow coma scale .The CT brain was suggestive of multiple small haemorrhagic contusions in both frontal lobes and left thalamus. Intraventricular haemorrhage in left lateral ventricle. Subgaleal hematoma in left frontal region. CT spine was normal. The MRI Brain showed multiple foci of blooming suggestive of hemorrhagic foci at the grey white matter interface in both frontal, temporal, parietal and occipital lobes, in the splenium of the corpus callosum ,left thalamus and in right pons. Features were suggestive of diffuse axonal injury. Dr. Prasad Consultant Neurosurgeon was consulted who advised conservative management. He was admitted in the ICU and electively ventilated for 72 hours for hyperventilation in view of the traumatic brain injury. In addition he received other treatment measures for reducing raised intracranial pressure. He also received anticonvulsants for post traumatic epilepsy and oral glycerol.
The clinical outcome is usually poor in patients with low GCS with the MRI Brain showing Grade III diffuse axonal injury. However the neuroplasticity of the brain in children can result in dramatic recovery. A regular follow up is needed to monitor the cognitive function of the child and the possibility of developing seizure disorder.
The child showed dramatic clinical improvement with the Glasgow coma scale completely normalizing to 15/15.He has started taking oral feeds. He is recongnizing his parents .He has started walking and running around and forming complete sentences. The repeat MRI brain has shown significant reduction in number of haemorrhagic foci.
Dr. Preethi Pereira
Department of Paediatrics
Manipal Hospital, Goa
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