Analysis and Preventive Measures for Misdiagnosis and Missed Diagnosis of Diffuse Axonal Injury in Children

WANG Xuecheng; ZHU Lei; ZHANG Min; LI Zhengwei; HUO Xiaoli

doi:10.3969/j.issn.1002-3429.2025.06.001

Abstract：Objective To analyze the causes of clinical misdiagnosis and missed diagnosis of diffuse axonal injury(DAI)in children,and to summarize its characteristics.Methods Retrospective analysis was performed on clinical data of two children with DAI admitted from May 2023 to May 2024,and the causes of misdiagnosis,missed diagnosis and preventive measures were summarized.Results One child was admitted to the hospital due to consciousness disorders after a car accident.No obvious abnor-malities were found on the head CT scan,and initial diagnosis was cerebral contusion and laceration.After 2 days of treatment in-cluding dehydration and symptomatic support,the condition did not improve.Afterwards,MRI examination revealed changes in DAI imaging,and the diagnosis was confirmed as DAI.The misdiagnosis lasted 2 d.After diagnosis,the child was given mannitol dehy-dration to reduce intracranial pressure and nutritional nerve medication treatment.Their consciousness gradually recovered and they were followed up for 6 months to resume normal life.One child was admitted to the hospital due to headache,vomiting,and tempo-rary loss of consciousness after a fall.CT examination showed mild subdural hematoma on the right side,and the initial diagnosis was subdural hematoma.Symptomatic treatment was given for subdural hematoma for 7 days,and the symptoms worsened.Subse-quent head MRI enhanced scan revealed diffuse damage to the corpus callosum and the central area of the semiovale,confirming the diagnosis of DAI with subdural hematoma.The missed diagnosis lasted 8 days.After diagnosis,dehydration to reduce intracranial pressure,nutritional nerve drugs,and hyperbaric oxygen therapy were given,along with early rehabilitation intervention.The child was able to walk independently after one month and was followed up for six months without significant sequelae.Conclusion DAI is prone to misdiagnosis as other cranial diseases and missed diagnosis due to its hidden imaging features and complex symptoms.For children with consciousness disorders after trauma,head MRI examination should be highly valued,and early diagnosis should be made based on medical history and clinical manifestations.Targeted treatment should be taken in a timely manner to improve prognosis.