Diagnosis:
Neuroimaging +Clinical features
Clinical features:
- Coma after head trauma: low GCS <8, with or without features to suggest structural cause (dilated pupills, disconjugate gaze, asymmetric posturing)
- Raise intracranial pressure (ICP ) often occurs
Neuroimaging:
CT:
- May be normal
- May show petechial hemorrhages in the whitematter (corpus callosum, corona radiata, cerebral peduncles)
- May show diffuse cerebral edema
MRI
- Mirrors findings on CT but is more sensitive
- GRE: very sensitive for associated hemorrhages and diffuse axonal injury
- DWI: may show diffuse axonal injury (abnormally restricted diffusion)
Pathology:
- Petechial hemorrhage (diffuse vascular injury) in corpus callosum, superior cerebellar peduncle & other white matter
- Microscopically: eosinophilic dystrophic (swollen) axons, beaded axons
- Immunohistochemistry: positive for beta amyloid precursor protein BetaAPP
Treatment:
- Supportive care
- Management of raised intracranial pressure