Have you ever watched a fight scene in a martial arts movie during which one opponent kicks the other in the head? Did you ever wonder what happens to the brain at that very moment?
To find out, read to learn about diffuse Axonal Injury (DAI).
Diffuse Axonal Injury (DAI)
● Diffuse Axonal Injury (DAI) is a form of traumatic brain injury commonly seen in high-speed motor vehicle accidents, assaults (sudden 90-degree rotation of the head), falls, and shaken baby syndrome.
● In this type of injury, the white matter of the brain (corpus callosum, frontal temporal lobe, and the brainstem) is severely damaged, causing a malfunction in the neurons and their communication with the rest of the brain.
● Seeking medical attention immediately is highly recommended. The prognosis is poor in patients with severe DAI.
● Clinical presentation of patients depends on initial assessment of the Glasgow Coma Scale (GCS). The GCS scores patients’ neurological function based on their clinical symptoms and the severity of DAI.
What is the Glasgow Coma Scale?
● The GCS measures three functions: eye opening, verbal response, and motor response.
● The initial GCS and the severity of the traumatic brain injury (TBI) helps predict the probability of death from the injury.
● Mortality (death) rates increase the more the GCS score decreases. According to the GCS, the TBI scores range from 13-15 for a mild injury, 9-12 for a moderate injury, and 8 and below for a severe injury.
Treatment
● Advanced trauma life support protocol is the standard of care for all head injured patients (possible resuscitation and neurological treatment performed by a designated neurotrauma center ASAP, along with anticoagulation to prevent post-trauma seizures).
● The definitive diagnosis is made in post-mortem pathological examination of the brain tissue.
● In clinical practice, the diagnosis is made by understanding the cause of the head injury and performing an MRI of the brain.
● Currently there are no lab tests to diagnose DAI.
● Other treatments may involve preventing secondary injuries, such as hypoxia (low oxygen levels caused by difficulty breathing) with hypertension (high blood pressure), swelling, and intracranial hypertension (increased pressure in the brain), that could lead to death, rehab, and supportive care.
Side Effects
● The patient may be affected mentally and physically due to the possibility of multiple neurological defects.
● The quality of life for both the patient and the family may also be affected.
● The recovery is long.
● Patients with severe DAI will be disabled for the rest of their lives.
References
Alila Medical Media. (2019). Brain trauma with axon shear (car accident, shaken baby syndrome.).
[Diagram]. https://www.shutterstock.com/image-vector/brain-trauma-axon-shear-car-accident-89651788?src=libra
y
Mesfin, F.B., & Taylor, R.S. Diffuse Axonal Injury (DAI) [Updated 2019 Nov 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK448102/