Traumatic axonal injury revealed by postmortem magnetic resonance imaging: A case report |
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| Affiliation: | 1. Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;2. Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan;3. Laboratory of Neuropathology, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan;4. Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan;1. Coventry and Warwickshire Partnership NHS Trust, Caludon Centre, Clifford Bridge Road, Coventry, England CV2 2TE, United Kingdom;2. Division of Mental Health and Well-Being, University of Warwick, Gibbet Hill Road, Coventry, England CV4 7AL, United Kingdom;1. Forensic Medicine & Clinical Toxicology Department, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo 11562, Egypt;2. Forensic Medicine Authority, Ministry of Justice, 114 Berium Eltonsy Street, Elsayda Zainb, Cairo, Egypt;3. Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Germany;1. Centre for Forensic Anthropology, M420, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia;2. Department of Forensic Medicine, Hospital Sultanah Aminah, Ministry of Health Malaysia, Persiaran Abu Bakar Sultan, 80100 Johor Bahru, Johor, Malaysia;3. National Institute of Forensic Medicine, Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, 50586 Kuala Lumpur, Malaysia;4. Department of Radiology, Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, 50586 Kuala Lumpur, Malaysia;1. Trauma Center, Phoenix Children''s Hospital, Phoenix, AZ;2. Barrow Neurological Institute, Phoenix Children''s Hospital, Phoenix, AZ;3. Department of Child Health, University of Arizona, College of Medicine-Phoenix, Phoenix, AZ;4. Department of General Surgery, Mayo Clinic, Phoenix, AZ;1. Medical Examiner’s Office of Hyogo Prefecture, Kobe, Japan;2. Division of Legal Medicine, Department of Community Medicine and Social Healthcare Science, Kobe University Graduate School of Medicine, Kobe, Japan;3. Division of Genomic Medicine, Department of Advanced Medicine, Medical Research Institute, Kanazawa Medical University, Uchinada, Japan;4. Department of Developmental Medical Sciences, Graduate School of Medicine, University of Tokyo, Tokyo, Japan;5. Department of Forensic Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan;1. Department of Forensic Medicine, Graduate School of Biomedical Sciences, Tokushima University, Japan;2. Department of Forensic Medicine, Faculty of Medicine, Fukuoka University, Japan |
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| Abstract: | In forensic investigations, it is important to detect traumatic axonal injuries (TAIs) to reveal head trauma that might otherwise remain occult. These lesions are subtle and frequently ambiguous on macroscopic evaluations. We present a case of TAI revealed by pre-autopsy postmortem magnetic resonance imaging (PMMR).A man in his sixties was rendered unconscious in a motor vehicle accident. CT scans revealed traumatic mild subarachnoid hemorrhage. Two weeks after the accident he regained consciousness, but displayed an altered mental state. Seven weeks after the accident, he suddenly died in hospital. Postmortem computed tomography (PMCT) and PMMR were followed by a forensic autopsy.PMMR showed low-intensity lesions in parasagittal white matter, deep white matter, and corpus callosum on three-dimensional gradient-echo T1-weighted imaging (3D-GRE T1WI). In some of these lesions, T21-weighted imaging also showed low-intensity foci suggesting hemorrhagic axonal injury. The lesions were difficult to find on PMCT and macroscopic evaluation, but were visible on antemortem MRI and confirmed as TAIs on histopathology.From this case, it can be said that PMMR can detect subtle TAIs missed by PMCT and macroscopic evaluation. Hence, pre-autopsy PMMR scanning could be useful for identifying TAIs during forensic investigations. |
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| Keywords: | Diffuse axonal injury Autopsy Magnetic resonance imaging Forensic pathology Neuropathology |
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