PMC8087465_01
Axial FLAIR MRI showing Grade III DAI with hyperintense lesions at the level of the tectum of the midbrain, in the superior cerebellar parenchyma and the superior cerebellar peduncle.
EMI2021-5550371.001.jpg
PMC8087465_01_EMI2021-5550371.001.jpg
fig1
MRI of her head (see Figure 1) showed Grade III DAI involving the tectum of the midbrain bilaterally, the inferior colliculi, and the superior cerebellar peduncles bilaterally.
PMC8087465_02
Axial FLAIR MRI, showing Grade III DAI with hyperintense lesions evident in the left midbrain and pons.
EMI2021-5550371.002.jpg
PMC8087465_02_EMI2021-5550371.002.jpg
fig2
Her MRI (see Figure 2) showed a Grade III DAI with involvement of the left side of the midbrain and pons in addition to the right mesial temporal lobe.
PMC8087465_03
Axial FLAIR MRI showing injury in the medial aspect of the right cerebral peduncle close to the root entry zone of the right third nerve.
EMI2021-5550371.003.jpg
PMC8087465_03_EMI2021-5550371.003.jpg
fig3
However, an MRI showed a small haemorrhagic contusion along the lateral aspect of the left side of the midbrain and a very localised hyperintense signal change in the medial aspect of the right cerebral peduncle close to the root entry zone of the right third cranial nerve (see Figure 3).
PMC8087465_04
Axial FLAIR MRI showing multiple injuries in the tegmentum, tectum, and periaqueductal parenchyma of the midbrain, with involvement of the right cerebral peduncle, the right side of the pons, and the right middle cerebellar peduncle.
EMI2021-5550371.004.jpg
PMC8087465_04_EMI2021-5550371.004.jpg
fig4
Figure 4) showed a haemorrhagic shear injury affecting the tegmentum, tectum, and periaqueductal parenchyma of the midbrain, right cerebral peduncle, right side of the pons, right middle cerebellar peduncle, and superior aspect of the right cerebellar hemisphere. Management included prolonged intensive care unit stay (23 days) while he was kept deeply sedated and ventilated; during the admission, the left pupil regained a slight response to light, although the right one remained fixed and dilated. Following a long but sustained neurological recovery, he was back to full-time education without residual neurological deficits.
PMC8087465_05
Axial FLAIR and sagittal T1WI MRI showing a significant injury to the left midbrain and multiple intraparenchymal contusions in the frontal, temporal, and parietal lobes.
EMI2021-5550371.005.jpg
PMC8087465_05_EMI2021-5550371.005.jpg
fig5
The MRI (see Figure 5) showed multiple haemorrhagic lesions involving the corpus callosum and brainstem consistent with DAI, a contusion in the left internal capsule and in the left frontal lobe.