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[An infant with diffuse axonal injury]
1Department of Pediatrics, St. Luke's International Hospital, Tokyo.
Insights
Magnetic Resonance Imaging (MRI) aids in diagnosing head traumas like diffuse axonal injury (DAI) in infants. This case highlights MRI
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Trauma Imaging
Background:
- Conventional computed tomography (CT) has limitations in diagnosing subtle traumatic brain injuries.
- Diffuse axonal injury (DAI) is a severe form of traumatic brain injury, often associated with high-impact events.
- DAI is infrequently reported in infants, with most pediatric cases involving older children.
Observation:
- A 1-year-9-month-old infant sustained a fall from a significant height, presenting with altered consciousness and seizures.
- Initial brain CT scan upon emergency room arrival revealed no abnormalities.
- Subsequent MRI scans demonstrated characteristic findings consistent with DAI.
Findings:
- MRI offers superior sensitivity for detecting DAI compared to CT, especially in pediatric cases.
- This infant case demonstrates the feasibility of diagnosing DAI in very young children using MRI.
- Infantile DAI may present differently or be milder than in adults due to developmental factors.
Implications:
- Early and accurate diagnosis of DAI in infants via MRI can guide clinical management.
- Further research and accumulation of infantile DAI cases are crucial for understanding age-specific injury patterns.
- This case underscores the importance of advanced neuroimaging in evaluating non-accidental trauma or severe falls in infants.
Abstract:
Development of MRI enabled accurate and rapid diagnosis of head traumas which had been impossible with the conventional CT. The diagnosis of posttraumatic diffuse axonal injury (DAI) is a typical example. Most of the reported cases of DAI in childhood are of relatively older age, and DAI is rare in infancy. We report here a 1-year-9-month-old infant with DAI. After falling from two meters in height, he presented consciousness disturbance and a seizure that necessitated artificial respiration for half a day. He recovered completely without sequelae. Brain CT on arrival to the ER department was unremarkable, but MRI scans shortly thereafter showed typical findings of DAI. In childhood, DAI tends to be milder than in adult-hood, which may be explained by the age-dependent frequency of traffic accidents, and by anatomical and functional factors of a infant's brain. A large number of infantile cases should be accumulated to draw a more clearcut conclusion.