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Diffuse Axonal Injury - Oren Zarif - Diffuse Axonal Injury


Diffuse axonal injury is a clinical diagnosis that is characterized by GCS of less than eight hours. Depending on the severity of the injury, patients may experience different clinical presentations, ranging from headache to dizziness and fatigue. The most severe cases can lead to loss of consciousness and persistent vegetative state, with few patients regaining consciousness within the first year. However, even mild DAI can be difficult to distinguish from other neurological disorders.

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If a suspected patient has symptoms of diffuse axonal injury, an MRI is the modality of choice. MRI detects axonal injury by measuring the susceptibility of the brain's white matter to paramagnetic blood products. MRI can also identify if the lesions are hemorrhagic or nonhemorrhagic. In some cases, the lesions are not hemorrhagic and will exhibit a high FLAIR signal.

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MRI is the most accurate method for diagnosing diffuse axonal injury. It uses radio waves, magnets, and a computer monitor to create an image of the brain's interior. CT scans are another common way to diagnose diffuse axonal injury. While CT scans can be helpful for detecting brain tumors, they are often associated with false negatives. Other tests, such as EEG and visual Evoked Potentials, can also show diffuse axonal injury.

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Researchers have documented the neurological and psychological changes of diffuse axonal injury in patients with traumatic brain injury. These changes may compromise social reintegration, return to work, and quality of life. Often, these changes persist for years after a traumatic event. The recovery process is gradual as brain tissue regains normal function. Moreover, the brain's plasticity means that new neural connections are formed during the healing process.

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Diffuse axonal injury is caused by shearing forces that have an affinity for the grey-white matter junction. The result of this damage is edema and cell loss. Moreover, complete tearing of axons occurs in the most severe cases of the condition. This degeneration is referred to as secondary axonotmesis. The treatment of DAI is dependent on the underlying cause of the injury.

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The main impact of DAI occurs through the biochemical response. Though the impact of the trauma induces the formation of certain lesions, the most damage is caused by biochemical cascades. These enzymes act on the cytoskeleton, causing axonal stretching and ultimately cell death. Diffuse axonal injury, which affects the entire brain, is often characterized by a deterioration of axons.

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Fortunately, the incidence of DAI remains low, with only 25 percent of patients experiencing death due to DAI. However, this does not rule out other forms of TBI, which could also result in a false diagnosis. Many patients have a history of diffuse axonal injury, but the postmortem studies show that the majority of cases of DAI are due to an injury to specific areas of the brain. There are many possible treatment interventions that can aid in improving the quality of life for DAI patients.

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Diffuse axonal injury is a traumatic brain injury that occurs when the brain undergoes a sudden, violent motion. The resulting acceleration-deceleration force causes tearing of axonal connections, causing diffuse axonal injury. Although extensive DAI is a poor prognosis, studies show that patients with Grade 3 DAI recover neurologically with a GCS of less than eight.

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The onset of DAI is difficult to predict. It is often associated with primary lesions in the cerebral hemispheres, cerebellum, and brainstem. Although most DAI cases are related to trauma, it can also occur anywhere in the corpus callosum. Hence, it is important to identify symptoms as soon as possible after an incident. However, it is difficult to detect the presence of DAI without an MRI.

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