Diffuse Axonal Injury - Oren Zarif - Diffuse Axonal Injury
If your doctor suspects diffuse axonal injury, he may order MRI. MRI is sensitive to paramagnetic blood products, and can show susceptibility artefacts in the grey-white matter junction, corpus callosum, and brain stem. Sometimes, diffuse axonal injury does not cause hemorrhage, and a high FLAIR signal will indicate non-hemorrhagic lesions.
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Patients with diffuse axonal injury typically present with a variety of neurologic deficits during neurological examination. They frequently affect the temporal and frontal white matter, as well as the corpus callosum and brainstem. Diffuse axonal injury is characterized by pathophysiological lesions in white matter tracts and clinical presentation, and includes mechanical disruption of the cytoskeleton in the axonal portion of neurons.
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Diffuse axonal injury may be caused by a variety of injuries. Trauma may cause axonal disconnect, but the most common cause is secondary biochemical degeneration of neuronal tissue. Although many patients do recover from DAI, recovery signs are often positive. Patients with a rotational closed head injury are often suspected of suffering from diffuse axonal injury. The signs of recovery vary widely depending on the severity of the injury.
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After the diagnosis of DAI, doctors may perform a variety of treatment options. These treatments aim to reduce ICP and improve cerebral blood flow. Patients with severe DAI should expect prolonged rehabilitative therapy. Occupational therapy and speech therapy are among the common modalities employed to help with recovery. A physical therapist can also help regain control of body parts and stimulate neuroplasticity. The goal is to help the patient return to his normal activities and quality of life.
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Diffuse axonal injury is caused by forces that disrupt multiple areas of the brain. Different connections within the brain are disrupted, leading to a wide variety of secondary effects. Thankfully, many people recover from this condition and improve their quality of life. Axonal injury is caused when the brain is jarred and rapidly moved inside the skull. The impact causes the brain to repeatedly hit against the inside of the skull, causing long connecting fibers to tear.
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Large axons are surrounded by the oligodendrocytes and Schwann cells of the brain and peripheral nervous system. Oligodendrocyte membranes are layered and contain a lipoprotein called myelin. This membrane forms a multilayered sheath of fat, which resembles the insulation surrounding electrical wire. Myelin also allows nerve impulses to travel much faster within the nerve network.
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Diffuse axonal injury (DAI) is a complication of traumatic brain injuries and is responsible for approximately 40 percent of hospitalizations in children and young adults. Diffuse axonal injury affects many different areas of the brain, and often results in coma and neurological impairments. Because the changes are microscopic, they are not visible on MRIs or CT scans.
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DAI can have several causes, including the initial traumatic impact. In some cases, a significant amount of damage results after the traumatic impact. For example, Figure 4 shows the CT scan of a patient with DAI. If a patient has a fracture, the brain injury is more likely to cause DAI. However, a fracture can result in DAI in the brain, and it is important to recognize DAI in patients with an underlying neurological disorder.
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The results of DAI studies have shown that enlarged ventricles and a reduced ability to process information may be indicative of DAI. This is consistent with the impact of both types of injury on cognitive function. Further, DAI has been linked to the deposition of amyloid precursor protein, which is responsible for axonal atrophy, which is thought to play a role in memory. This has important implications for the care of people with DAI.
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Recent clinical trials of DAI have demonstrated that DTT-based quantification is effective at detecting early DAI and can reverse the injury in a patient. The study also showed that DTT-based quantification of three WM structures vulnerable to DAI correlates better with functional outcome than standard measures of injury severity. The study also revealed that DAI is associated with poor outcomes among patients with chronic TBI. However, further studies of the effectiveness of DTI measurements are needed.