Male, 23 months old, status post unrestrained motor vehicle collision, assess for diffuse axonal injury. Assess for spinal cord injury. Brain:Numerous scattered foci of restricted diffusion are seen, predominantly at the gray-white interface, within both cerebral hemispheres. Prominent diffusion restriction is demonstrated at the splenium of the corpus callosum. Restricted diffusion is also seen along the anteromedial thalami. Scattered punctate susceptibility effect are present in association with some of these lesions.No large intraparenchymal hematoma is seen. However, scattered trace FLAIR hyperintensity in the cerebral sulci probably reflects subarachnoid blood product as suspected on prior CT. A fluid level within the left occipital horn, and to a lesser extent in the right occipital horn, may also represent blood product. Trace subdural FLAIR hyperintensity is seen along the right occipital and temporal lobes compatible with minimal blood product.No evidence of significant parenchymal edema or generalized mass effect is seen. The expected flow voids are appropriately visualized. Ventricular size and morphology are within normal limits. Opacification of the paranasal sinuses and mastoid air cells is seen bilaterally.Cervical spine:The articulation of the right lateral masses of C1 and C2 is slightly widened and edematous. Mild edema is also seen within the posterior lateral paraspinal soft tissues at C1-2. The posterior atlantoaxial ligament is visualized and appears to be intact. The craniocervical junction and the remaining cervical ligamentous structures appear to be intact. No evidence of spinal malalignment is seen. The intervertebral discs are intact and the vertebral bodies show no evidence of marrow edema. The visualized spinal cord shows no obvious focal signal abnormality given the limitation of moderate motion artifact. No compromise of the spinal canal or neural foramina is seen.Airspace opacity and perhaps some pleural fluid are partially visualized on the right. The anterior tongue appears to be edematous.
1.Multiple intracranial findings are seen compatible with diffuse axonal injury. In addition, scattered trace subarachnoid and subdural blood product is redemonstrated. Mild intraventricular blood product is seen without evidence of ventricular dilatation.2.No definite evidence of spinal cord injury is seen within the limitations of motion artifact. However, there are findings to indicate ligamentous injury involving the articulation of the right lateral masses of C1 and C2. Soft tissue injury is also seen within the posterior lateral paraspinal soft tissues at C1-2. No vertebral body or disc injuries are evident.