PURPOSE Diffuse axonal injury (DAI) is the rupture of multiple axons due to acceleration and deceleration forces during a closed head injury. Most traumatic brain injuries (TBI) have some degree of DAI, especially severe TBI. Computed tomography (CT) remains the first imaging test performed in the acute phase of TBI, but has low sensitivity for detecting DAI, since DAI is a cellular lesion. The aim of this study is to search in the literature for CT signs, in the first 24 h after TBI, that may help to differentiate patients in groups with a better versus worst prognosis. METHODS We searched for primary scientific articles in the PubMed database, in English, indexed since January 1st, 2000. RESULTS Five articles were selected for review. In the DAI group, traffic accidents accounted 70% of the cases, 79% were male, and the mean age was 41 years. There was an association between DAI and intraventricular hemorrhage (IVH) and traumatic subarachnoid hemorrhage (tSAH); an association between the IVH grade and number of corpus callosum lesions; and an association between blood in the interpeduncular cisterns (IPC) and brainstem lesions. CONCLUSION In closed TBI with no tSAH, severe DAI is unlikely. Similarly, in the absence of IVH, any DAI is unlikely. If there is IVH, patients generally are clinically worse; and the more ventricles affected, the worse the prognosis.

中文翻译：

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急性创伤后弥漫性轴索损伤的早期计算机断层扫描：系统评价。

目的 弥漫性轴突损伤 (DAI) 是在闭合性头部损伤期间由于加速和减速力导致多个轴突断裂。大多数创伤性脑损伤 (TBI) 都有一定程度的 DAI，尤其是严重的 TBI。计算机断层扫描 (CT) 仍然是在 TBI 急性期进行的第一个影像学检查，但由于 DAI 是一种细胞病变，因此检测 DAI 的敏感性较低。本研究的目的是在文献中搜索 TBI 后最初 24 小时内的 CT 征象，这可能有助于区分预后较好和最差的患者。方法 我们在 PubMed 数据库中检索了自 2000 年 1 月 1 日起索引的英文原始科学文章。结果 选择了五篇文章进行审查。DAI组交通事故占70%，男性占79%，平均年龄41岁。DAI 与脑室内出血 (IVH) 和创伤性蛛网膜下腔出血 (tSAH) 之间存在关联；IVH等级与胼胝体病变数量之间的关联；以及脚间水池（IPC）中的血液与脑干病变之间的关联。结论 在没有 tSAH 的封闭式 TBI 中，不太可能出现严重的 DAI。同样，在没有 IVH 的情况下，任何 DAI 都不太可能出现。如果有IVH，患者一般临床情况更差；受累的心室越多，预后越差。不太可能出现严重的 DAI。同样，在没有 IVH 的情况下，任何 DAI 都不太可能出现。如果有IVH，患者一般临床情况更差；受累的心室越多，预后越差。不太可能出现严重的 DAI。同样，在没有 IVH 的情况下，任何 DAI 都不太可能出现。如果有IVH，患者一般临床情况更差；受累的心室越多，预后越差。