Diffuse Axonal Injury Treatment - Oren Zarif - Diffuse Axonal Injury
In patients with diffuse axonal injury, treatment focuses on prevention of secondary injuries and rehabilitation. Secondary injuries can include edema, hypotension, and elevated intracranial pressure. To minimize these outcomes, prompt care is necessary. Patients should be monitored closely and receive physical and occupational therapies. The following is a list of treatments that may be used to alleviate symptoms of diffuse axonal injury. Some of these therapies may be used immediately after the initial injury.
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Diffuse axonal injury causes behavioral, cognitive, and physical changes that compromise social reintegration, productivity, and quality of life. The severity of DAI may depend on the type of injury and the risk factors associated with it. This disease may last for many years, even after traumatic events have healed. In addition, it can interfere with an individual's ability to perform normal daily activities, such as walking.
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Diffuse axonal injury may be diagnosed through a postmortem pathologic examination of the brain tissue. Radiographic findings and clinical information can also help in the differential diagnosis of DAI. Patients who sustain a rotational closed head injury should be suspected of suffering from DAI. Acute diffuse axonal injury is an extremely serious condition, and the likelihood of recovery varies greatly. In some cases, patients may be permanently incapacitated.
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In most cases, diffuse axonal injury is localized in the rostral brainstem, near the superior cerebellar peduncles. These lesions typically appear as hemorrhagic spots, but over time, these areas can become a shrunken mass of scarring. Although DAI usually occurs in the dorsolateral quadrant of the brainstem, it can occur anywhere in the midbrain.
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Recovery from diffuse axonal injury can be significantly enhanced with rehabilitative therapy. Physical therapy can help individuals regain movement control and stimulate neuroplasticity. Physical therapy can also target the body parts affected by DAI, which will help activate neuroplasticity in the affected area. Axonal injuries can also be a sign of a traumatic brain injury. It is critical to seek rehabilitation for any individual who has suffered from diffuse axonal injury.
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Patients with DAI will have ventricular dilatation and loss of surrounding white matter. These patients tend to be unconscious at the time of impact. The severity of the DAI causes secondary and tertiary lesions to develop in the cerebrum, corpus callosum, and brainstem. This condition is associated with a decreased survival rate. It is also a significant cause of coma in patients with severe TBI.
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Diffuse axonal injury is a relatively common cause of coma in patients with high-impact head injuries. However, it is not always easy to diagnose post mortem. Pathologists need to know what to look for. In recent years, increasing knowledge of the mechanisms of axonal injury have led to the development of three distinct grades of DAI: Axonal, focal, and diffuse. The severity of DAI will affect each patient's recovery.
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Diffuse axonal injury occurs when a brain shifts quickly within the skull. The force of this movement tears axons, disrupting communication between nerve cells in the brain. In severe cases, patients may be in a coma for six hours or more. The increased pressure inside the skull can also lead to a vegetative state. The severity of Diffuse axonal injury will be determined by the GCS.
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During a high-speed collision, axons are subject to traumatic shearing forces due to the sudden acceleration. These forces are particularly harmful to axons in the grey-white matter junction, where they meet the cortex. Diffuse axonal injury can also result in mechanical disruption of the axonal cytoskeletal structure. When these axons are destroyed, they will no longer align correctly, resulting in abnormal alignment. Consequently, amyloid precursor proteins and Tau are aberrantly deposited.
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In addition to DAI severity, there are other factors that contribute to mortality in patients with DAI. The severity of DAI and the presence of gliding contusions or basilar grooves are known early signs of DAI. In addition to the symptoms of the injury, imaging studies can also detect the severity of DAI. A patient with DAI is diagnosed after 72 hours of hospitalization. The patient's RR may be normal or slightly above or below the normal range.
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Several factors contribute to the development of secondary injuries associated with diffuse axonal injury. One of these factors is the influx of calcium and sodium into the cells. While this process doesn't occur immediately after the injury, it is active within 15 minutes and four hours. It is associated with neurofilament collapse, loss of axonal microtubules, and activation of several lipases. These abnormalities cause an increase in inflammatory eicosanoids and the production of strong oxidants.