Diffuse Axonal Injury

Diffuse Axonal Injury

A diffuse axonal injury, or DAI injury, is one of the more severe types of closed head injuries. It is also one of the most common traumatic brain injuries. It is called a diffuse injury because, unlike focal brain injuries, it affects the whole brain. Here, we'll discuss what diffuse axonal injury is and what can be done to treat this injury.

What Is Diffuse Axonal Injury | A Closer Look

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The Primary Cause of Diffuse Axonal Injury

The symptoms of these types of injuries gradually progress if left untreated, so quick treatment is very important. While most other traumatic brain injuries are caused by a blow to the head, diffuse axonal injuries are caused by the sloshing around of the brain within the skull. A closed head injury is actually considered more dangerous than an open head injury. This is because the brain tissue is torn, and there is secondary swelling with no place for the swelling to go.

What Happens If You Suffer from DAI

In a diffuse axonal injury, the brain movements disrupt the axons of the nerve cells which are there because the neurons need to talk to one another. If this is diffused within the brain, there is a severe disruption of the messaging system of the brain. This can easily result in a coma or in a persistent vegetative state. Once the nerve cells are disrupted, the links that tie them together become broken, and the signaling process cannot occur. The different functions such as speech, movement, and respiratory system fail to function. The end result can be death relatively quickly after an injury. When a patient enters a coma, greater than 90 percent never wake up.

Other Causes of DAI

Diffuse axonal injury can be caused by a shaking of the head or by a strong rotation of the head. Common causes of this type of injury are shaken baby syndrome or car accidents. Diffuse axonal injury occurs because the brain lags behind the skull movement, causing tearing of blood vessels and nerve tissue in all parts of the brain. Brain chemicals are then released by damaged nerve cells, worsening the injury. When the nerve cells are torn, there can be no communication between the various nerve cells. This brain disturbance can lead to temporary or permanent brain damage, coma, persistent vegetative state, or death.

Diagnosis and Symptoms of Diffuse Axonal Injury

Diagnosis and Symptoms of Diffuse Axonal Injury | Diffuse Axonal Injury Diagnosis and Treatment

The biggest indication the patient is having a diffuse axonal injury is unconsciousness. The patient then enters a coma from which the vast majority does not recover. Many people enter into a persistent vegetative state where the patient has a sleep-wake cycle but talks little and is completely bedridden. Some patients never enter the persistent vegetative state but die because they lack the necessary brain cells to sustain life. A few patients awaken from their coma but have severe neurological deficits and cannot function in society.

When it comes to diagnosis of diffuse axonal injury, much is based on the clinical findings of unconsciousness and coma. The test most often used in diagnosing diffuse axonal injury is the CT scan. This test combines x-ray technology and computer to give a detailed three-dimensional image of the person’s brain. There can be false negatives with the CT scan, so it can’t completely be relied upon to give the diagnosis of the diffuse axonal injury.

One can also do a test called evoked potentials, which is usually called a BAER test, an SSEP test, or a VEP test. These tests examine the auditory, visual, and sensory pathways within the brain. In diffuse axonal injury, these pathways will be disrupted. An EEG or electroencephalogram is also a good test for diffuse axonal injury. This test uses electrodes attached to the scalp that measures the electrical activity within the brain. In diffuse axonal injury, the EEG will be abnormal.

Treatment and Prognosis of Diffuse Axonal Injury

Initially, measures will be taken to decrease the swelling of the brain. Mannitol, steroids, and other medications are used to decrease swelling and reduce the inflammation of the brain. The patient will be carefully monitored. Surgery will not help this injury.

If the diffuse axonal injury is mild or moderate, the patient will enter rehabilitation once they are awake and stable. In the rehabilitation phase, both the family and the patient will be managed by a multidisciplinary staff that will include nurses, doctors, occupational therapists, physical therapists, and other specialists who will work with the patient to return the patient to a normal state or at least to the maximum level of function they are capable of. This can include physical therapy, speech therapy, recreational therapy, occupational therapy, adaptive equipment training, and mental/emotional counseling.

Over a period of weeks to months, the patient will improve to a maximum level. A concussion is believed to be the mildest form of diffuse axonal injury. There are various forms of the severity of this illness, with mild to moderate forms of the disease having the best recovery chances. The mildest cases of diffuse axonal injury usually have few, if any, long-term problems. People with severe injuries often live out their lives in a persistent vegetative state or die at an early age from complications of a coma.

An Experienced Brain Injury Attorney

I'm Ed Smith, a personal injury lawyer for Northern California. If you or a member of your family has suffered a brain injury in a car accident, you may be reimbursed for your suffering, medical expenses, pain, and lost wages. Give me a call today for a free and friendly advice on your situation. I can be reached at (916) 921-6400 or (800) 404-5400.

I have been serving individuals and families in the Sacramento area and around Northern California for the past 35 years. You can find reviews from my past clients on the following websites:

Press play on the video below from SMUVideo to know about an SMU student who recovered from a traumatic brain injury:

With the right knowledge and understanding about diffuse axonal injury, you'll know what to do and expect in case this happens to someone you know. This injury could be life-threatening, but you can always maximize the treatment resources you have to help the patient recover, at least to the maximum level the patient can handle. The recovery may take a while, but with the help of experts and the different types of therapies available, the patient can progress.

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Editor's Note: This article has been updated for accuracy and relevancy. 

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