Author: Karen A. Tong, M.D.

Loma Linda University Medical Center, CA, USA

Authored date: 2006-06-02

Case 1

Patient History
A 14-year-old female who was ejected 20 feet from an automobile in a motor vehicle accident. She had an initial Glasgow Coma Score (GCS) of 3. She was in a coma for 8 days, and in hospital for 93 days. MRI was obtained 11 days after injury.

Image Findings
SWI images showed numerous small hemorrhages throughout the deep brain, consistent with diffuse axonal injury. In these images, the small hemorrhages in the corpus callosum and thalami are better seen on the SWI image than on the conventional GRE (Gradient Echo) image.

Traumatic Brain Injury: deep shearing injuries in corpus callosum and thalami. A:Conventional GRE, B: SWI

Results and Discussions
On long-term follow- up she had severe disability.

Case 2

Patient History
A 12-year-old female who was a passenger in an automobile that struck a pole. Her initial GCS was 6. She was in a coma for 6 days and in the hospital for 29 days.

Image Findings
SWI images showed multiple small hemorrhages throughout the deep brain, consistent with diffuse axonal injury. In these images, the small hemorrhages in the temporal lobes and occipital horns are better seen on the SWI image than on the conventional GRE image.

Traumatic Brain Injury: contusions and intraventricular hemorrhage. A: Conventional GRE, B: SWI

Results and Discussions
On longterm follow-up she had moderate disability.

Case 3

Patient History
An 11-year-old male who was riding a motorcycle when struck by an automobile. His initial GCS was 6. He was in a coma for 26 days, and was in hospital for 105 days. MRI was obtained 8 days after injury.

Image Findings
SWI images showed multiple small hemorrhages throughout the deep brain, consistent with diffuse axonal injury. In these images, the small hemorrhages in frontal and temporal lobes, and midbrain, are better seen on the SWI image than the conventional GRE image.

Traumatic Brain Injury: contusions & shearing Injuries. A: Conventional GRE, B: SWI

Results and Discussions
On long-term follow-up he had moderate disability.

Case4

Patient History
A 60-year-old male who was involved in a rollover motor vehicle accident and was trapped under a semi-tractor trailer.

Image Findings
SWI shows extensive dark signal outlining the surface of the brain, consistent with subarachnoid hemorrhage. A dark fluid or FLAIR image shows bright signal in the parietal sulci, confirming recent bleeding. Hyperdense subarachnoid hemorrhage was also seen on computed tomography images (not shown).

Fig. 1  Traumatic Brain Injury: subarachnoid hemorrhage A: CT examination, B: T2 weighted image, C: Dark Fluid, D: SWI

Fig. 2  Traumatic Brain Injury: subarachnoid hemorrhage. SWI images.

Case 5

Patient History
A 57-year-old female with chronic headaches.

Image Findings
An incidental venous angioma was found in the right hemisphere. This is best seen on the SWI images, and is barely visible on the TSE (Turbo Spin Echo) T2 image.images (not shown).

Case 6

Patient History
A 7-year-old male who presented with visual disturbance.

Image Findings
He was found to have multiple cavernomas in the brain on MRI, best seen on the SWI images, compared to the GRE and TSE T2 images.

Multiple Cavernomas, A: T2, B: T2*, C: SWI.

* post-processing