Fig 1.

Diffuse axonal injury. This 17-year-old boy had a severe TBI in a motorcycle crash and had an initial GCS score of 5. Intracranial pressure was normal. Axial T2 and SWI images at the level of the centrum semiovale (A and B) and at the level of the lateral ventricles (C and D) are depicted. Small hemorrhagic shearing injuries in the left frontal subcortical white matter (arrows) are more are visible on SWI (B). At the lower level, SWI (D) shows additional small hemorrhagic shearing foci (open arrows) in the left frontal white matter, right subinsular region, and left splenium that are only partly visible on T2-weighted images. He was discharged 16 days after admission with moderately impaired cognition. Two years after injury, he continues to have fine-motor deficits. He has significant impairments on measures of verbal functioning (verbal comprehension, learning, and memory).