Severe and extensive traumatic axonal injury following minor and indirect head trauma

ABSTRACT

Objectives: This study reports on a patient with mild traumatic brain injury (TBI) who showed severe and extensive traumatic axonal injury (TAI) of various neural tracts following minor and indirect head trauma, which was demonstrated by diffusion tensor tractography (DTT).

Case description: A 26-year-old female patient suffered from indirect head trauma resulting from flexion-hyperextension injury after being hit from behind by a slowly moving car. At the time of head trauma, she felt tingling sensation on her four extremities; however, she did not experience loss of consciousness. At 5-day after onset, she began to experience tremor on the right leg and, subsequently, tremor had also developed in the left leg. At 8-days after onset, she could not even stand due to tremor of both legs and began to feel a tingling sensation on both legs. Since ~ 2 weeks after head trauma, myoclonus had developed mainly in the trunk. After 10-weeks after head trauma, when she started rehabilitation, she showed mild quadriparesis (4⁺/4⁺) with severe weakness of the proximal joint (shoulder/hip, 4^–/4^–), severe resting and intentional tremor, ataxic gait and severe myoclonus.

Conclusions: Severe and extensive TAI of various neural tracts was demonstrated in a patient with mild TBI following minor and indirect head trauma, using DTT.

KEYWORDS:

• Mild traumatic brain injury
• traumatic axonal injury
• diffusion tensor imaging
• tremor
• myoclonus

Declaration of interest

The authors report no conflicts of interest. This work was supported by the National Research Foundation (NRF) of Korea Grant funded by the Korean Government (MSIP) (2015R1A2A2A01004073).