Diffuse Axonal Injury - Oren Zarif - Diffuse Axonal Injury
Diffuse axonal injury is not caused by a single blow to the head. It is caused by the brain moving back and forth within the skull, either through acceleration or deceleration. It disrupts the axons that allow neurons to send messages. In severe cases, the brain can become unconscious or enter a vegetative state. While it is rare for a person to die from diffuse axonal injury, it does have potentially devastating consequences.
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Although DAI may be difficult to diagnose in the acute phase, a combination of clinical signs and imaging are typically suggestive. Ultimately, a postmortem examination is required for a definite diagnosis. Although CT is not a definitive tool for diagnosis, it can help to identify hemorrhages, as well as assess the status of the soft tissues. In addition, CT has low resolution when used for soft-tissue evaluation after a TBI. Nevertheless, it is a useful tool for early diagnosis of DAI. It is available in trauma centers and is conducive to use in unstable patients.
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Diffuse axonal injury has several consequences, including the comorbidity of other medical conditions and the patient's ability to return to the workplace. Patients with diffuse axonal injury experience significant changes in physical, mental, and cognitive status, which can make their quality of life and social reintegration impossible. Further, these changes last far beyond the acute phase of treatment and the recovery of a patient. The recovery process involves stabilizing the clinical condition, but the brain's plasticity is a major factor in restoring function.
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While some lesions result from impact, the most significant impact is caused by biochemical pathways. Axons are disrupted through biochemical cascades. The biochemical response is also responsible for axonal disconnect. These pathways are triggered by the physical stress and stretching caused by the impact. This process disrupts proteolytic metabolism and the degradation of the cytoskeleton. In addition, it opens up sodium channels, which allows impulses to cross over a synapse.
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People with diffuse axonal injury often have multiple areas of the brain affected. Disruptions to long nerve fibers in the brain can cause a variety of secondary effects. Many patients recover the function affected and improve their quality of life. Axonal injuries can occur in a variety of circumstances, including falling and traumatic brain injury. The injury can affect many aspects of a person's life, including memory and cognitive skills.
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In the case of severe DAI, a clinical diagnosis is likely. A patient's GCS is below 8 for more than six hours is often diagnosed with diffuse axonal injury. In most cases, patients will experience some degree of neurological dysfunction, ranging from a mild headache to a comatose state. Approximately 40 to 50% of patients with DAI will require hospitalization. A doctor can help determine whether the diagnosis is correctable with the proper testing and medication.
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Diffuse axonal injury occurs in the rostral brainstem near the superior cerebellar peduncles. It usually appears as hemorrhagic areas, but may develop into shrunken scarring. Although the primary location of DAI is the brainstem, DAI can occur anywhere in the corpus callosum. If left untreated, this condition may result in longer periods of coma and a decreased ability to learn and process information.
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There is no definitive way to identify the causes of DAI, but a number of risk factors have been identified. DAI may lead to a significant amount of damage after the initial traumatic impact. Figure 4 shows the CT scan of a patient with DAI. The axonal injury may be caused by a sudden or prolonged bout of seizures. Although the traumatic events are relatively minor, they may lead to permanent brain damage.
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The forces generated during MVC are similar to those induced by an elastic material stretched beyond its breaking point. These forces lead to substantial deformation of intracellular contents. Inertial forces appear to be essential in the development of DAI. The longer the critical force, the more work is done, and more injury is induced. The magnitude of the injury has been measured using the acceleration/time curve. Although DAI is not a direct result of MVC, the force and the resulting cellular deformation are directly related.