Beyond Cortical Contusions: Grade II Diffuse Axonal Injury Following a 60-Foot Fall in an Adolescent

A bstract This case highlights diffuse axonal injury (DAI) following a 60-foot fall in a pediatric patient, a recognized but less commonly reported mechanism compared to motor vehicle collisions. In pediatric patients who sustain head trauma secondary to falls, the incidences of skull fractures and hemorrhage are more common than those of DAI. This case report exemplifies the diagnostic challenges associated with DAI in a polytrauma case and describes a patient who sustained polytrauma involving an open left distal humerus fracture, right pneumothorax, hemoperitoneum, pelvic fracture, facial bone fractures, and severe traumatic brain injury. She required intensive care unit admission and multidisciplinary medical and surgical management. Clinicians should maintain a high index of suspicion for DAI in children after high-height falls, even when initial computed tomography brain imaging shows no significant intracranial hemorrhage.