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Diffuse Axonal Injury --- A quick review of high yield points

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By Ashesh

Diffuse axonal injury is a type of brain injury caused by trauma in cases of sudden acceleration-deceleration. It is commonly seen in cases of high-speed vehicle accidents. 



Which areas of the brain are affected by this type of injury?

It mostly affects the areas where brain matter density difference is maximum. Therefore, the most commonly affected areas are gray-white junctions. It affects white matter nerve fiber tracts in these regions.

Clinical Findings:

Although the findings can vary from insignificant to comatose state, most cases are classified as severe with a GCS score of less than 8. Symptoms include 

  • headache, 
  • dizziness, 
  • nausea, vomiting, 
  • loss of consciousness, etc


File: Compare SWI and GRE Trauma.png

Source: Karen Tong Author: SBarnes

Diagnosis:

Diffuse axonal injury is diagnosed clinically. The clinical findings in these patients are out of proportion to CT Imaging findings. The patient is unconscious and may even go into a vegetative state.  

Generally, a diagnosis is made if GCS is less than 8 for more than 6 hours following a high-speed vehicle accident. It is also considered in cases of failure to improve after surgical management of EDH or SDH. 

The CT findings of diffuse axonal injury are:

  • many minutes punctate hemorrhages and 
  • blurring of the gray-white interface of the brain.

Treatment:

There is no specific treatment. Early management or prevention of associated hypotension, hypoxia, and increased ICP is necessary. Patients are managed at intensive care units and Neurosurgery and neurology, consultations are necessary.

The prognosis of this condition is usually poor. Recovery, if occurs, occurs over a long period of time, and in most cases there is no complete recovery. 

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