Traumatic axonal injury despite clinical phenotype of mild traumatic brain injury: a case report

ABSTRACT

Objectives: We report on a patient who suffered traumatic axonal injury (TAI) of various neural tracts despite airbag deployment following mild traumatic brain injury (TBI), which was demonstrated by diffusion tensor tractography (DTT).

Case description: A 58-year-old female patient suffered from head trauma resulting from an in-car traffic accident. At the time of head trauma, her head and face hit the deployed airbag after flexion-hyperextension-rotation injury. The patient’s Glasgow Coma Scale score was 15. Since the day of head trauma, she began to feel headache and upper back pain at the mid-thoracic area. At 7 days after onset, she began to feel pain on the left hand, which spread to the right hand and leg: throbbing and cold pain without allodynia or hyperalgesia (visual analogue scale score: 5). She also felt mild weakness of all four extremities and mild memory impairment. On 4-week DTT, the corticospinal tract showed partial tearing at the subcortical white matter level in both hemispheres . The right fornical crus and right anterior cingulum were discontinued, and narrowing and partial tearing were observed in both spinothalamic tracts.

Conclusions: TAI of four kinds of neural tracts was demonstrated in a patient with mild TBI despite airbag deployment, using DTT.

KEYWORDS:

• Mild traumatic brain injury
• traumatic axonal injury
• diffusion tensor tractography
• airbag

Declarations 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) (number 2015R1A2A2A01004073).