Diffuse Axonal Injury: Ethiologi, Diagnosa, And Treatment | |||||||||
A diffuse axonal injury is caused by a shaking or rotation of the head that causes the brain to move within the skull. Nerve tissue is torn or sheared (thus, these are also called shearing injuries)and the brain may release chemicals that cause more injury. It’s common in car accidents and can occur without a skull fracture or brain contusion. Diffuse axonal injuries can be very difficult to diagnose because CT Scans and MRIs may not detect them and they may result in permanent cognitive and behavioral injuries. (1) The outcome is frequently coma, with over 90% of patients with severe DAI never regaining conciousness.(2)Those who do wake up often remain significantly impaired.(3) Nowadays, other authors state that DAI can occur in every degree of severity from (very) mild or moderate to (very) severe.(4,5)Concussion may be a milder type of diffuse axonal injury.(6) DIAGNOSE Diffuse injury has more microscopic injury than macroscopic injury and is difficult to detect with CT and MRI, but its presence can be inferred when small bleeds are visible in the corpus callosum or the cerebral cortex.(7) MRI is more useful than CT for detecting characteristics of diffuse axonal injury in the subacute and chronic time frames.(8) Newer studies such as Diffusion Tensor Imaging are able to demonstrate the degree of white matter fiber tract injury even when the standard MRI is negative. medical professionals should suspect DAI in any patients whose CT scans appear normal but who have symptoms like unconsiousness.(2) STAGES of DAI
Adam J.H (1989) Diffuse axonal injury in head injury: definition diagnosis and gradingHistopatologyn 15(1):49-59 Potential Treatment Polyethylene glycol acts as a membrane sealant, and may serve to prevent the aforementioned devastating calcium influx. Rats treated with polyethylene glycol immediately following DAI induction showed no cytotoxic edema on diffusion weighted MRI 7 days later unlike controls.(9) Refferences: 1. Methaler. J. M. 2001 " Current Concepts: Diffuse axonal Injury-associated TBI". Archives of physical medicine and rehabilitations 82(10) : 1461-71 2. Wasserman J. and Koenigsberg R.A. (2007).Diffuse Axonal Injury. Emedicine.com. Retrieved on 2008-01-26. 3. Vinas F.C. and Pilitsis J. (2006). Penetrating head trauma. Emedicine.com. Retrieved on 2008-01-14. 4. Vik A., Kvistad, K.A., Skandsen, T. & Ingebritsen, T. (2006). Diffus aksonal skade ved hodetraume. Tiddskr. Nor. Lægeforen. 126: 2940-44. 5. Smith, D.H. and Meaney D.F. (2000). Axonal damage in traumatic brain injury. The Neuroscientist. 6 (6): 483—495. 6. Sivák Š, Kurča E, Jančovič D, Petriščák Š, Kučera P (2005)."An outline of the current concepts of mild brain injury with emphasis on the adult population 7. Crooks CY, Zumsteg JM, Bell KR (November 2007). "Traumatic brain injury: A review of practice management and recent advances". Phys Med Rehabil Clin N Am 18 (4): 681–710. 8. Maas AI, Stocchetti N, Bullock R (August 2008). "Moderate and severe traumatic brain injury in adults". Lancet Neurology 7 (8): 728–41. 9. Smucker, P; Hekmatyar, SK; Bansal, N; Rodgers, RB; Shapiro, SA; Borgens, RB (2009). "Intravenous polyethylene glycol successfully treats severe acceleration-induced brain injury in rats as assessed by magnetic resonance imaging.".Neurosurgery 64 (5): 984–990. (Edited by admin elearning - original submission Monday, 12 November 2012, 08:00 AM) |
Re: Diffuse Axonal Injury: Ethiologi, Diagnosa, And Treatment | |
Is there any surgical treatment needed? |