A case report on delayed: onset diffuse axonal injury

Diffuse axonal injury (DAI) is characterized by immediate loss of consciousness lasting for more than 6 hours following traumatic head injury. It can be classified into three grades based on the duration of coma, severity, and the presence of radiological or histological evidence of lesions in various parts of the brain.

In this report, we present a case of a 20-year-old non-alcoholic male sustaining a head injury following a fall from a swing. On presentation, his Glasgow Coma Scale (GCS) was 15, which greatly fluctuated between 10 and 15 during hospitalization. MRI of the brain was suggestive of grade three DAI. Unusually, he went into a coma after 50 hours of admission. He was subsequently intubated and managed conservatively at our facility.

DAI is one of the major causes of disability, post-traumatic coma, and persistent vegetative state following traumatic events. It is typically marked by an immediate loss of consciousness, resulting in only a few cases being recognized with delayed presentation. This case report exemplifies a unique and noteworthy instance of delayed onset DAI.

DAI is often associated with traumatic brain injury (TBI), and it should always be suspected when the clinical presentation of the patient is significantly more severe than the initial computed tomography (CT) head findings. Maintaining a strong clinical suspicion and considering the possibility of unusual findings can facilitate prompt diagnosis and management of patients with DAI in clinical practice.