II. Pathophysiology

  1. Severe Traumatic Brain Injury from rotational acceleration and deceleration forces
  2. Affects the grey matter-white matter junctions

III. Signs

  1. Severe Head Injury (high velocity impact or deceleration injury)
    1. Coma or severe confusion
    2. Glasgow Coma Scale (GCS) 8 or less
  2. Autonomic Dysfunction
    1. Fever
    2. Hypertension
    3. Diaphoresis

IV. Imaging

  1. CT Head
    1. Diffuse cerebral swelling
    2. White matter blends into gray
    3. Punctate Hemorrhages
  2. MRI Brain
    1. Punctate Hemorrhages within white matter tracts

V. Management

  1. Neurosurgery Consultation
  2. Intracranial Pressure monitoring and other neurosurgical intervention may be indicated

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