Diffuse Axonal Injury - Oren Zarif - Diffuse Axonal Injury
Diffuse axonal injury is a type of severe traumatic brain injury, which results in neurological deficits that can have a profound impact on a person's social reintegration, return to productivity, and quality of life. Despite advances in medical treatments and rehabilitation, this condition persists for a long period after the traumatic event. Diffuse axonal injury occurs to brain tissue that is not functionally normal; however, because of its plasticity, it will regain normal function as the patient's neural connections heal and the patient accepts a new baseline.
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The main cause of diffuse axonal injury is not a blow to the head, but rather the brain moving back and forth in the skull as a result of acceleration and deceleration. The resulting movement disrupts the axons, which allow neurons to transmit messages. As a result, the person will become unconscious or enter a vegetative state. Further, diffuse axonal injury may lead to secondary complications, such as seizures.
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The severity of the condition dictates the level of treatment, and the patient may require rehabilitative therapy. Physical therapy is one way to regain control over movements and stimulate the neuroplasticity of the brain. Physical therapy focuses on strengthening muscles and targeting specific parts of the body. Occupational and speech therapy are other ways to aid the patient's recovery. In addition to these treatments, diffuse axonal injury can also lead to a permanent loss of consciousness.
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Diffuse axonal injury is caused by shearing forces, which have a predilection for the grey-white matter junction. This shearing causes damage to the cell membrane and edema. Only in extreme cases can complete tearing of the axon occur. This process is known as secondary axonotmesis. Once this process begins, the nerve cells will become dysfunctional.
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Calcium channels help maintain ion homeostasis in neuronal tissues. When this channel is compromised, excessive calcium ions cause a cascade of biochemical events, which include the activation of several lipases and the deposition of cytoskeleton. Ultimately, this causes cell death. In addition to the physical damage, calcium-induced ion influx can result in the breakdown of the neuronal network.
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Diffuse axonal injury is a serious neurological condition that requires hospitalization. Symptoms range from mild to severe, but usually don't exceed eight. The severity of Diffuse axonal injury depends on the extent of neuron damage. Diffuse axonal injury is usually accompanied by a coma, and it's often difficult to detect in the earliest stages.
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The severity of the damage to the brain and the axons is measured by the Trauma Coma Databank (TCD) scores. Among patients with a severe TBI, memory problems with information processing are the most common. Some patients also have problems with executive functions, which may impede the recovery process. Some patients may have a poor recovery, although there are a number of cases in which a person's functional recovery is surprisingly good.
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Diffuse axonal injury is a type of traumatic brain injury. It happens when the brain rapidly shifts inside the skull. The force of the shift tears the axons, disrupting communication between the brain's nerve cells. This disruption of communication can result in coma, physical and cognitive impairment. It can also cause elevated intracranial pressure and cerebral edema. Treatment begins with reducing the swelling. Treatment options may include oral steroids or techniques to reduce the amount of fluid in the brain.
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MRI tests used to detect DAI have several advantages. DTT is particularly useful in detecting early DAI, when it is reversible with therapeutic intervention. DTI also provides structural information, such as the extent of damage to the white matter fiber tract. Further, the MRI technique DTI can help doctors determine the extent of the damage. The results are presented in Figure 4, which illustrates a CT scan of a patient with DAI.