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By: CHRISYE LENA BAURA 2008 83 033 dIFFUSE VASCULAR INJURY (DVI)JOURNAL1

TERMINOLOGYDiffuse vascular injury (DVI) probably represents the extreme end of the diffuse axonal injury continuum.2

etiologyDVI caused by the extreme acceleration / rotational forces that are incurred in high-velocity motor vehicle collisions (MVCs).The brain microvasculature is disrupted by high tensile forces, resulting in numerous small parenchymal hemorrhages3

pathologyGROSS PATHOLOGY. Autopsied brains of patients with DVI show numerous small hemorrhage in the subcortical and deep white matter as well as in the deep gray nuclei (2-74).2-74. Autopsy case shows findings of diffuse vascular injury with multiple petechial and linear subcortical injury to thalamus , corpus callosum splenium .

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MICROSCOPIC FEATURES. Many more hemorrhages are detected on microscopic examination than are seen in the gross appearance of the brain. Blood is identified along periarterial, perivenous, and pericapillary spaces with focal hemorrhages in the adjacent parenchyma.5

CLINICAL ISSUE6

IMAGING7

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2-75 A. NECT in a male patient involved in a high-speed, high impact MVC shows only diffuse brain swelling. GCS was 8 at the scene; by the time he reached the emergency department, the GCS had decreased to 3.2-75 B. MR was obtained because of the gross discrepancy between clinical and imaging findings. T2WI shows hyperintensities in the right thalamus and WM of both frontal lobes . Torn arachnoid is probably responsible for the small bifrontral hygromas .2-75 C. SWI in the same patient shows innumerable linear and ovoid blooming hypointensities in the subcortical and deep WM consistent with diffuse vascular injury.9

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DIFFERENTIAL DIAGNOSISThe major differential diagnosis is diffuse axonal injury (DAI). While some lessions in DAI are hemorrhagic, the majority are not. DVI is characterized by the presence of innumerable petechial hemorrhages on T2* imaging. It is the number, severity, and extent of the hemorrhages that distinguishes DVI from DAI.

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2-76. Autopsy specimen from a patient who died in a high-speed MVC shows a large hemorrhage in the deep gray nuclei, characteristic of severe subcortical injury.

2-77. NECT scan in a patient with post-traumatic subcortical injury shows a large expanding basal ganglia hematoma .11

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