Diffuse Axonal Injury Treatment - Oren Zarif - Diffuse Axonal Injury
In acute and chronic diffuse axonal injuries, the goals of treatment include prevention of secondary injuries and facilitation of rehabilitation. Because secondary injuries increase mortality, treatment should focus on preventing these complications. These include cerebral edema, hypoxia with coexistent hypotension, and increased intracranial pressure. Prompt care is essential to avoid cerebral edema and elevated intracranial pressure. Although there are no known cures for diffuse axonal injury, treatment options for the condition are available.
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Diffuse axonal injury affects the grey-white matter junction. The traumatic shearing forces induced by the trauma result in an immediate brain injury. Microtubules will then become destroyed and align incorrectly. As a result, proteins like tau and amyloid precursor protein will be abnormally deposited. The severity of diffuse axonal injury determines the treatments that are recommended. The most effective treatments are those that minimize or prevent brain injury.
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Diagnosis of diffuse axonal injury is challenging. The symptoms of the disorder vary, depending on the area of the brain injured, the patient's health, and the type of treatment received. In addition, it can be difficult for doctors to differentiate between mild and severe diffuse axonal injuries. Further, axonal injuries are often difficult to diagnose and require detailed imaging to ensure the correct diagnosis. In many cases, no diagnosis will be possible unless the patient undergoes a thorough examination with neuroimaging.
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The goal of postoperative care is to reduce ICP and improve cerebral blood flow. In patients with severe DAI, postoperative rehabilitation is likely to involve extended physical, occupational, and speech therapy. However, even if the patient survives, rehabilitative therapies are necessary. They are not only critical in restoring function and quality of life, but they may also help predict long-term outcomes. This research is a necessary step in the development of health policies and multidisciplinary treatment for diffuse axonal injury.
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Axonal damage from a head injury is a serious medical condition, and it should be carefully evaluated to determine the underlying cause. In the case of grade 1 diffuse axonal injury, the presence of multiple focal lesions within the white matter, corpus callosum, and brainstem suggests a severe and persistent neurologic injury. The most common symptoms include headache, nausea, fatigue, and dizziness. In severe cases, the patient may lose consciousness and stay in a vegetative state. Only a small minority of patients with diffuse axonal injury will recover consciousness within the first year after the injury.
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When diagnosing diffuse axonal injury, MRI is recommended. MRI is sensitive to paramagnetic blood products, and it can detect the lesions at the grey-white matter junction, the corpus callosum, and the brain stem. Sometimes, lesions are not hemorrhagic, but will show up as a high FLAIR signal on MRI. In these cases, a neurologic rehabilitation program is necessary to restore function and quality of life.
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If the trauma is severe enough, the patient may undergo neuropsychological testing to determine the severity of the damage. These tests include a cranial computed tomography and magnetic resonance imaging. MRI can help determine if the patient has diffuse axonal injury and what the extent of cognitive impairment is. In severe cases, neuropsychological testing can also clarify the extent of cognitive impairment. A medical doctor will likely perform extensive neuropsychological tests to determine the extent of the damage.
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In an animal model of DAI, high calcium levels activate an ion pump in the axon. The calcium influx, however, is not triggered immediately. This calcium influx is not accompanied by an increase in Ca-ATPase activity until 15 minutes or four hours after the injury. High calcium levels activate several lipases, including calpains, which are associated with apoptosis and necrosis.
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In a clinical setting, DAI is often the primary cause of coma in patients with traumatic brain injury (TBI). Although DAI is not necessarily a result of a TBI, it can accompany subdural hematomas. It is the most common type of lesion in patients with rotational acceleration-deceleration head injury (RADI), and occurs most commonly in the rostral brainstem, corpus callosum, and dorsolateral brainstem.
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However, there is limited data on clinical and sociodemographic factors related to mortality after diffuse axonal injury (DAI). The study of 51 patients with DAI was conducted with a standardized cohort design and based on Trauma Coma Databank scores. Patients were divided into independent and dependent groups based on their DAI severity and long-term functional outcome. However, some limitations of the study prevented us from confirming the results.