Diffuse Axonal Injury - Oren Zarif - Diffuse Axonal Injury
Diffuse axonal injury is a type of traumatic brain injury, characterized by a variety of neurological deficits. The consequences of such injuries affect patients' social reintegration, productivity, quality of life, and return to work. Diffuse axonal injury can persist long after the traumatic event. Although brain tissue is functionally impaired, it eventually recovers its normal function, if the patient is stabilized clinically. The brain's plasticity allows the neural connections to rebuild and regenerate.
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When the damage is moderate, diffusion axonal injury may result in microscopic white matter changes in the cerebral cortex and corpus callosum. In more severe cases, focal lesions of the brainstem are found. In patients with diffuse axonal injury, the resulting cellular changes may be significant and necrotic. However, the effects of diffuse axonal injury may be minimized with early diagnosis and appropriate treatment.
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In the postoperative period, the primary goal of treatment is to reduce ICP and increase cerebral blood flow. Patients with severe DAI may experience long-term rehabilitation therapies including physical, occupational, and speech therapy. However, these rehabilitative therapies may take time. It may take several months before the symptoms of DAI are completely alleviated. In the meantime, the patient's life expectancy can be significantly prolonged. Therefore, patients should expect lengthy rehabilitative treatments after diffuse axonal injury.
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Diffuse axonal injury is difficult to diagnose on MRI alone, and may result in severe neurological impairment. Patients with DAI commonly present with symptoms ranging from mild to severe, and the GCS is usually below eight. Further, some patients may experience an absence of consciousness or a persistent vegetative state. In addition, few patients regain consciousness within a year. The recovery time may be prolonged or even completely reversible.
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Diffuse axonal injury is a distinct group of head injuries and can result in ventricular dilatation and loss of adjacent white matter. The majority of DAI cases are unconscious at the time of impact, with recovery of movement occurring several days afterward. Patients with DAI may initially appear restless and have autonomic symptoms. If there is a history of rotational closed head trauma, it is likely that the patient will suffer from DAI.
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Diffuse axonal injury is often present in the rostral brainstem, near the superior cerebellar peduncles. Axonal injury often presents as hemorrhagic lesions that eventually shrink and form scarring. It is not restricted to the brainstem but can occur anywhere in the midbrain. It is more common in adults and children with head trauma. The resulting symptoms are largely similar to those experienced by stroke victims.
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Diffuse axonal injury can be devastating for both the victim and the healthcare team. It occurs when the brain shifts quickly inside the skull, causing damage to the long connecting fibers of the brain. These injuries disrupt the normal communication between nerve cells in the brain, causing cognitive and physical impairment. Many people with Diffuse axonal injury are able to recover the affected functions and improve their quality of life.
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In patients who do not have hemorrhagic DAI, initial noncontrast CT may show multiple small hypodense foci. These foci are ovoid-shaped and correspond to sites of shear injury. In addition, patients may also have associated hemorrhages. Once detected, DAI should be suspected if clinical findings are significantly different from those of focal lesions. These results can be further clarified by a detailed neuropsychological examination.
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In the absence of MRI, DAI is the most likely cause of coma in patients with TBI. The presence of epidural hematomas, subdural hematomas, or both are associated with DAI. It is the primary lesion of rotational acceleration-deceleration head injury. It typically results in hemorrhagic foci in the corpus callosum, rostral brainstem, and dorsolateral brainstem.