Abstract
Although diffuse axonal injury (DAI) frequently manifests as cognitive and/or motor disorders, abnormal brain findings are generally undetected by conventional imaging techniques. Here we report the case of a patient with DAI and hemiparesis. Although conventional MRI revealed no abnormalities, diffusion tensor imaging (DTI) and fibre tractography (FT) revealed the lesion speculated to be responsible for hemiparesis. A 37-year-old woman fell down the stairs, sustaining a traumatic injury to the head. Subsequently, she presented with mild cognitive disorders and left hemiparesis. DTI fractional anisotropy revealed changes in the right cerebral peduncle, the right posterior limb of the internal capsule, and the right corona radiata when compared with the corresponding structures observed on the patient's left side and in healthy controls. On FT evaluation, the right corticospinal tract (CST) was poorly visualised as compared with the left CST as well as the CST in healthy controls. These findings were considered as evidence that the patient's left hemiparesis stemmed from DAI-induced axonal damage in the right CST. Thus, DTI and FT represent useful techniques for the evaluation of patients with DAI and motor disorders.
Highlights
Diffuse axonal injury (DAI) is widely accepted as one of the most common types of primary neuronal injury in patients with severe head trauma [1,2,3,4]
DAI results from damage to the white matter caused by unequal rotation and/or deceleration/acceleration forces acting on the brain parenchyma that stretch and injure axons [1, 2, 5, 6]
We reported that it was possible to visualize the cause of paralysis evaluated by Diffusion tensor imaging (DTI) and fibre tractography (FT) for a DAI patient with hemiparesis which shows no lesion in conventional magnetic resonance imaging (MRI)
Summary
Diffuse axonal injury (DAI) is widely accepted as one of the most common types of primary neuronal injury in patients with severe head trauma [1,2,3,4]. DTI uses MRI to quantify fractional anisotropy (FA), which characterises the degree and directionality of water diffusion (anisotropy) [10, 11]. FA values have been reported to be useful in detecting various types of white matter damage, which might not be prominent on T1-weighted or T2-weighted MR imaging [8, 10, 11]. FT utilises similarities between neighbouring voxels with regard to the shape and orientation of the diffusion ellipsoid.
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