Diffuse Axonal Injury and Diffusion Tensor Tractography - Oren Zarif - Diffuse Axonal Injury

Diffuse axonal injury is one of the common consequences of traumatic brain injury. It occurs most often in the parasagittal white matter, corpus callosum, and brainstem. Diffusion tensor tractography is a noninvasive neuroimaging method used to detect axonal injury and determine the long-term functional outcome of patients. In this study, we compared patients with healthy controls using tract-derived fiber variables.

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Diffuse axonal injury, or DAI, occurs when there are multiple focal lesions throughout the brain, usually in the grey-white matter junction, corpus callosum, or brainstem. While non-contrast CT of the brain is routinely performed in patients with head injuries, it is not sensitive enough to detect subtle diffuse axonal injury. Patients with a normal CT scan may have significant unexplained neurological deficits, including a coma, paralysis, or permanent brain damage.

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The physical, behavioral, and cognitive changes of people with DAI result in the loss of ability to return to daily life and contribute to the social and economic situation. The damage remains long after the acute phase of treatment. In most cases, DAI patients will continue to exhibit symptoms for up to two years after the initial event. After stabilization of the clinical state, however, their brains will regain their normal function. However, these changes will only occur when patients have accepted the new baseline that they have inherited.

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Although the impact of an accident on an individual can cause axonal damage, biochemical processes are what primarily cause the most damage. The disruption of proteinolytic metabolism and degradation of the cytoskeleton is caused by biochemical pathways. The biochemical pathways also lead to axonal disconnect. The impact also disrupts cytoskeleton integrity and opens sodium channels in the axolemma. These processes cause the axons to tear.

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Diffuse axonal injury is often the result of shearing forces applied to the white-matter fiber tracts. This condition is most often associated with high-impact trauma and is typically characterized by a prolonged unresponsiveness or coma. However, patients who have suffered DAI may recover movement. Initially, diffuse axonal injury patients may appear restless, have autonomic symptoms, and lack the ability to speak or move.

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Diffuse axonal injury is often caused by trauma to the brainstem, where white matter is made up of myelinated axons. This tissue connects the gray matter, which contains neuronal cell bodies and regulates the transmission of neuronal impulses. Diffuse axonal injury is usually mild, with only slight white matter lesions visible on T1-weighted images. But despite its widespread symptoms, there is no specific treatment for DAI. Treatment includes limiting intracranial pressure and stabilizing the patient.

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The factors involved in traumatic brain injury are known to control the initial inflammatory response, reduce calcium and sodium influx into the cell, alter immune processes, and sustain neurotrophic factors. All these processes will enhance the recovery process. Once the traumatic brain injury is characterized by the presence of these factors, the factors involved in the process will need to be monitored closely. However, it is not uncommon for the injury to recur despite the traumatic brain trauma.

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When diffuse axonal injury is the result of a brain trauma, several areas of the brain are affected. The brain's long fibers are ripped during the rapid shift inside the skull. As the brain continues to shift within the skull, the axons get severed and the brain begins to function slowly. The majority of people who have Diffuse axonal injury will remain in a coma or worsen. Diffuse axonal injury can be difficult to diagnose with CT or MRI scans. It is one of the most devastating forms of traumatic brain injury.

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Diffuse axonal injury is the result of differential motion between white and gray matter due to differences in density. This causes axonal stretching as the overlying cortex moves at a faster rate than the white matter. This is the major cause of coma and poor outcome in most patients with closed head injuries. In severe cases, patients can die or remain in a vegetative state. In mild to moderate cases, rehabilitation is possible.