【双语病例】Diffuse Axonal Injury 弥漫性轴索损伤

Description

A healthy 22-year-old individual with no history of alcoholism, in a coma after a road traffic accident

患者22岁,既往体健,无酗酒史。外伤后昏迷。

【双语病例】Diffuse Axonal Injury 弥漫性轴索损伤

【双语病例】Diffuse Axonal Injury 弥漫性轴索损伤

【双语病例】Diffuse Axonal Injury 弥漫性轴索损伤

【双语病例】Diffuse Axonal Injury 弥漫性轴索损伤

【双语病例】Diffuse Axonal Injury 弥漫性轴索损伤

【双语病例】Diffuse Axonal Injury 弥漫性轴索损伤

LegendsAxial T2 FLAIR (A, B) shows multiple subcortical white matter and corona radiata T2-hyperinstense lesions, with diffuse hyperintensity and mild swelling of the splenium. Axial DWI (C) shows diffuse periventricular white matter and callosal diffusion restriction. Axial T2 GRE (D) shows no hemorrhagic component. Sagittal T2WI (E) shows the splenial signal abnormality, with relative sparing of the reminder of the corpus callosum.

横断位T2-FLAIR(A,B)示皮层下白质区及放射冠多发高信号,胼胝体压部轻度水肿,呈弥漫性高信号。

横断位DWI(C)示脑室周围白质及胼胝体弥散受限。

横断位T2-GRE序列(D)未见明显出血成分。

矢状位T2WI(E)示胼胝体压部信号异常。

【双语病例】Diffuse Axonal Injury 弥漫性轴索损伤

Diffuse Axonal Injury

弥漫性轴索损伤

Background

  • Diffuse axonal injury (DAI) or shearing injury is an indirect brain injury that affects primarily the white matter.弥漫性轴索损伤(DAI)或剪切伤,是脑白质损伤为主的间接损伤。
  • Sudden angular rotation of the head appears the most likely underlying mechanism.其损伤机制是头部的突然旋转。
Clinical FeatureClassically, patients with DAI present with low GCS starting at the moment of impact.

DAI患者的典型表现为:外伤后哥斯拉昏迷评分(GCS)降低。

Key Diagnostic Feature

  • DAI is characterized by usually (80%) nonhemorrhagic white matter lesions mostly sparing the overlying cortex.约80%的DAI典型表现为皮层下白质区非出血性病变。
  • The areas most commonly involved in DAI are the subcortical white matter, corpus callosum (especially splenium), corona radiata, internal capsule, and the dorsolateral aspect of the upper brainstem.DAI最常累及的部位:皮层下白质区、胼胝体(尤其是压部)、放射冠、内囊、脑干背外侧。
  • FLAIR and DWI are the most useful imaging sequences for nonhemorrhagic DAI, whereas T2*-weighted sequences and SWI are more sensitive for hemorrhagic DAI.FLAIR和DWI序列有助于非出血性DAI的诊断;T2*WI和SWI对小出血灶的检出更敏感。
DDxCerebral fat embolism

该病需要与外伤后的脑脂肪栓塞相鉴别:

  • Usually there is an associated long bone fracture and a 24–72 hour latency period (rather than immediate) before decreased GCS.一般来说,脑脂肪栓塞多伴有四肢长骨的骨折,在GCS降低前可以有24-72小时的潜伏期。
  • Typically associatied with respiratory distress and skin petechiae.典型病例可伴有呼吸困难、皮肤瘀斑。
  • DWI will show diffuse punctuate hyperintense foci called a “star field pattern”.DWI示多发散在高信号灶,呈“星空征”。
RxSupportive measures, standard neuroprotection. Prognosis is poor if there is involvement of the brainstem.

支持治疗、神经保护。如果病变累及脑干,一般预后很差。

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