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Traumatic Microhemorrhages Are Not Synonymous With Axonal Injury.

Karinn Sytsma1, Rhonda Mittenzwei1, Heather Maioli2

  • 1Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.

Annals of Clinical and Translational Neurology
|January 21, 2026
PubMed
Summary
This summary is machine-generated.

Diffuse axonal injury (DAI), a consequence of traumatic brain injury (TBI), is often identified by microbleeds on susceptibility-weighted MRI (SWI). However, this study found axonal injury in only 64% of these microbleeds, revealing a complex injury pattern.

Keywords:
axonal injuryneuropathologytraumatic microhemorrhages

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Area of Science:

  • Neuroscience
  • Radiology
  • Pathology

Background:

  • Diffuse axonal injury (DAI) results from shearing forces in white matter tracts during traumatic brain injury (TBI).
  • Susceptibility-weighted MRI (SWI) detects microbleeds, considered a hallmark of DAI for prognostication.
  • Existing assumptions about SWI microbleeds as definitive DAI markers lack robust radiologic-pathologic correlation.

Purpose of the Study:

  • To investigate the direct correlation between SWI-identified microbleeds and actual axonal injury in severe TBI.
  • To assess the reliability of SWI microbleeds as the sole indicator of DAI.

Main Methods:

  • Ex vivo SWI was performed on three human brains from severe TBI patients.
  • Immunohistochemistry for amyloid-beta precursor protein was used to identify and assess axonal injury.
  • Microscopic examination focused on areas surrounding SWI-detected microbleeds.

Main Results:

  • Axonal injury was detected in 64% of the microbleeds identified by SWI.
  • This indicates that not all SWI microbleeds are associated with DAI.
  • The findings highlight a heterogeneous response of white matter to TBI.

Conclusions:

  • SWI microbleeds are not uniformly indicative of diffuse axonal injury.
  • Radiologic findings of microbleeds in TBI require careful interpretation alongside pathological evidence.
  • Further research is needed to understand the full spectrum of white matter injury in TBI.