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Fornix Injury in a Patient With Diffuse Axonal Injury

Sung Ho Jang, MD; Seong Ho Kim, MD, PhD; Oh Lyong Kim, MD, PhD
Arch Neurol. 2009;66(11):1424-1425. doi:10.1001/archneurol.2009.242.
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Diffuse axonal injury (DAI) is characterized by widespread axonal damage due to shearing forces by acceleration, deceleration, or rotation of the brain.1Diffuse axonal injury is the most frequent cause of poor clinical outcomes in patients with traumatic brain injury.1However, conventional brain magnetic resonance imaging is not sufficiently sensitive to diagnose DAI, as most DAI lesions are microscopic.2Recent advancements in diffusion tensor tractography (DTT) have allowed the fornix to be visualized 3-dimensionally.35 Wang et al5 demonstrated that the fornix bodies of patients with DAI were injured using the data obtained from DTT. In the current study, we describe a patient with DAI who showed a fornix injury on DTT.

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Brain magnetic imaging in a 40-year-old man with diffuse axonal injury. A, Brain magnetic resonance images taken 30 months after the injury showed leukomalactic lesions in the isthmus of the corpus callosum (red arrows) and the cingulate gyrus (blue arrows). The diffusion tensor tractography of the patient (B) showed that the posterior portion of the fornix body was disrupted (yellow arrow) compared with that of a normal control (C). L indicates left; R, right; A, anterior; and P, posterior.

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