Diffuse axonal injury (DAI) is a common and fatal type of brain injury caused by shear forces that damage axons. It is difficult to diagnose and can result in unconsciousness and severe impairment. Treatment involves supportive care and therapy, with varying prognosis and costs.
Diffuse axonal injury (DAI) is a type of brain injury that involves damage to axons, caused by shear forces that push tissues in the brain relative to each other. As the “diffuse” in the name suggests, a diffuse axonal lesion can cover a large area of the brain, as opposed to a focal lesion, where the damage is concentrated in one region. These injuries can be difficult to diagnose because the damage may not always be visible on medical imaging studies.
Diffuse axonal injuries are classically caused by things like traffic accidents, falls, and abuse. Anything that shakes, rapidly rotates, or abruptly decelerates the head can lead to diffuse axonal injury, because it puts extra strain on the brain. The hallmark symptom of this type of injury is unconsciousness. In about 90% of patients, the patient never actually regains consciousness after an IAD, and for the 10% who do wake up, recovery can be a long process.
This type of brain injury is extremely common and is among the most fatal types of brain injury. At the mild end of the spectrum, diffuse axonal injury can cause a concussion. More commonly, people become severely impaired. Individuals who regain consciousness generally require a large amount of supportive care, and improvements in their condition are usually seen within the first year, although therapy and treatment should continue after this point.
Immediate treatment for a diffuse axonal injury involves supporting the patient while they are unconscious. The pressure within the skull is closely monitored so it can be relieved if it gets too high, and the patient can be placed on a ventilator if they experience difficulty breathing. For patients who do not regain consciousness, lifelong support in a treatment facility for people with traumatic brain injury is required. For patients who wake up, recovery may include physical therapy, speech therapy, occupational therapy, and other supportive measures to help the patient regain as much function as possible.
The prognosis for someone with diffuse axonal injury varies. Some people heal very well and may have no long-term effects. Other people may need lifelong supportive care, but are otherwise quite independent, and some develop severe impairments that require them to have helpers at all times. Patients who do not regain consciousness are unlikely to improve, and the costs of their care can be extremely high.
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