What is Diffuse Axonal Injury? - Oren Zarif - Diffuse Axonal Injury

Diffuse axonal injury (DAI) is a condition that damages the white matter tracts of the brain. It can cause a wide variety of neurological symptoms, ranging from the clinically insignificant to comatose. The GCS of patients with diffuse axonal injury is less than eight, and patients are often young men. The symptoms of diffuse axonal injury vary widely, and a diagnosis of DAI is often difficult.

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One example of a DAI is when a driver texts and rear-ends a stopped vehicle without hitting the brakes. This sudden impact causes the body and brain to shift in their seats, and the resulting force forces the white and gray matter in the brain to tear. While the resulting trauma is usually minor, the symptoms can become severe if not treated promptly. Here are some things to know about DAI.

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MRI is the first modality of choice in suspected DAI. MRI is sensitive to paramagnetic blood products, and it can detect the presence of a susceptibility artefact at the grey-white matter junction, corpus callosum, and brain stem. In addition to these findings, a patient's neurologic status will likely improve after treatment, but they will be left with lifelong disabilities.

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In mild forms of DAI, the main effect is coma without a focal lesion. The symptoms of DAI include a range of secondary effects. The patient may develop a cognitive deficit, such as poor memory or confusion. Physical therapy is another form of rehabilitative therapy for a patient with DAI. These therapies help regain control of movement and the affected body parts. Further, they can stimulate neuroplasticity, which is the ability of the brain to adapt and regenerate.

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Diffuse axonal injury is a complication of head injury. It occurs when an injury causes damage to axons throughout the brain. The brain tissue is then injured by changes in the velocity of a high-velocity fluid, resulting in damage to the axons. In severe cases, an axon may completely tear, leaving the brain without any functional connection.

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In vitro models of DAI cause the brain to shift rapidly inside the skull. The force of the shift causes the axons to tear and disrupt communication between nerve cells in the brain. These disruptions in communication can cause a coma or physical or cognitive impairment. Diffuse axonal injury can also lead to elevated intracranial pressure. Treatment of this injury begins with the reduction of swelling. This may include treatment with oral steroids, as well as techniques that reduce the fluid in the brain.

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The clinical diagnosis of diffuse axonal injury (DAI) can be determined by Gennarelli's classification. If a patient scores six or higher on the best motor response test, it is considered to have a mild DAI. Severe DAI, on the other hand, may be due to a more serious condition. Although the effects of DAI are not clear, it does show an important incidence of DAI in postmortem studies.

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While CT may be able to determine the presence of DAI, MRI has superior sensitivity in detecting its characteristics. DTI also correlates with the modified Rankin score and GCS scores. Therefore, DAI is the leading cause of coma in patients with closed head injuries. Although this condition may cause a coma in patients with TBI, it is often a significant contributor to the poor outcome of the patient.

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In the early stages of a DAI, it is not clear exactly which brain areas are affected. However, the midbrain, corpus callosum, and brainstem all show signs of damage. However, early CT scans may show minimal changes, indicating that the axonal damage is mostly microscopic. In more severe cases, the patient will have a more difficult time recovering from "awareness" in the long run.