, Volume 36, Issue 12, p 1326
Date: 31 Aug 2006

Diffusion-weighted imaging of Wallerian degeneration in non-accidental head injury

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An 11-month-old infant with clinical, ophthalmological and radiological findings (including intracranial haemorrhage) of 24–72 h estimated duration, consistent with non-accidental injury showed hyperintense signal on diffusion-weighted imaging (DWI) and decreased apparent diffusion coefficient (ADC) in the cerebral cortex, including the motor cortex, bilaterally, indicating cytotoxic oedema (Fig. 1). There was no abnormality in the cerebral peduncles. Follow-up MRI 18 days later showed DWI hyperintensity and decreased ADC in the cerebral peduncles and evolving infarct (T2-W/FLAIR hyperintensity and parenchymal loss) in the motor cortex (Fig. 2). These observations were interpreted as Wallerian degeneration. Fig. 1

MRI on admission
Fig. 2
Follow-up MRI 18 days later

Wallerian degeneration is antegrade degeneration of axon and myelin sheaths following injury of the cell body and/or proximal axon and its presence is associated with a poor neurological outcome [1]. DWI is useful in detecting t