A 26-Year-Old Man Is Brought to the Emergency Department After

A 26-year-old man is brought to the emergency department after a high-speed motorcycle collision.  The patient was thrown several feet after his motorcycle collided with a car.  On arrival, he is profoundly comatose.  A CT scan of the head performed within an hour of the event shows no abnormalities.  The patient dies several hours later, and autopsy examination is performed.  Brain histopathology shows widespread axonal swelling, predominantly at the gray-white junction.  Immunohistochemical staining of these axons reveals accumulation of alpha-synuclein and amyloid precursor proteins.  Which of the following is the most likely cause of these observed findings?

A) Diffuse cerebral hypoperfusion
B) Disruption of the bridging cortical veins
C) Glutamate-mediated neuronal injury
D) Interruption of the white matter tracts
E) Secondary microvascular spasm

Correct Answer:

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