Diffuse axonal injury and rim enhancing contusions

Discussion:

This case demonstrates two important imaging appearances.  

The first is that of a typical severe diffuse axonal injury (Grade 3), as well complex base of skull fractures, seen in the acute setting after a high speed motor vehicle accident.

The subsequent CT and MRI demonstrate the presence of rim enhancement in a resolving contusion - an appearance that may cause diagnostic confusion, needing to be differentiated from other cerebral ring enhancing lesions.

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