The CT finding of small punctate hemorrhages after severe traumatic brain injury is most consistent with which diagnosis?

• A. Diffuse axonal injury
• B. Subgaleal hemorrhage
• C. Cushing's Syndrome
• D. Cerebral capillary hemorrhage

Answer: (A)

Diffuse axonal injury presents with small punctate hemorrhages in the white matter on CT after a severe traumatic brain injury. These tiny hematomas reflect axonal shearing forces that disrupt neural connections across multiple tracts, especially at the gray-white junction, corpus callosum, and brainstem. Because the injury is diffuse rather than a single mass lesion, CT may show scattered microhemorrhages rather than a focal contusion, which fits the pattern described. Subgaleal hemorrhage involves bleeding under the scalp and would not account for intracerebral punctate hemorrhages. Cushing’s syndrome is a systemic response to increased intracranial pressure and not a CT finding; cerebral capillary hemorrhage is not the standard description for this setting.