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. 2020 Jun;62(6):653-660.
doi: 10.1007/s00234-020-02383-2. Epub 2020 Mar 4.

Early computed tomography for acute post-traumatic diffuse axonal injury: a systematic review

Giovana Figueira Rodrigues Vieira  1 , José Fernando Guedes Correa  2
Affiliations

Early computed tomography for acute post-traumatic diffuse axonal injury: a systematic review

Giovana Figueira Rodrigues Vieira et al. Neuroradiology. 2020 Jun.

Abstract

Purpose: Diffuse axonal injury (DAI) is the rupture of multiple axons due to acceleration and deceleration forces during a closed head injury. Most traumatic brain injuries (TBI) have some degree of DAI, especially severe TBI. Computed tomography (CT) remains the first imaging test performed in the acute phase of TBI, but has low sensitivity for detecting DAI, since DAI is a cellular lesion. The aim of this study is to search in the literature for CT signs, in the first 24 h after TBI, that may help to differentiate patients in groups with a better versus worst prognosis.

Methods: We searched for primary scientific articles in the PubMed database, in English, indexed since January 1st, 2000.

Results: Five articles were selected for review. In the DAI group, traffic accidents accounted 70% of the cases, 79% were male, and the mean age was 41 years. There was an association between DAI and intraventricular hemorrhage (IVH) and traumatic subarachnoid hemorrhage (tSAH); an association between the IVH grade and number of corpus callosum lesions; and an association between blood in the interpeduncular cisterns (IPC) and brainstem lesions.

Conclusion: In closed TBI with no tSAH, severe DAI is unlikely. Similarly, in the absence of IVH, any DAI is unlikely. If there is IVH, patients generally are clinically worse; and the more ventricles affected, the worse the prognosis.

Keywords: Computed tomography; Diffuse axonal injury; Post-traumatic coma; Traumatic brain injury.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flowchart depicting the literature search. Source: Flowchart created by author
Fig. 2
Fig. 2
Type of accident. Source: Figure created by author
Fig. 3
Fig. 3
Mean age. Source: Figure created by author
Fig. 4
Fig. 4
Sex. Source: Figure created by author
See this image and copyright information in PMC

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