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Diffuse Axonal Injury: Ethiologi, Diagnosa, And Treatment
by dr prabudi - Thursday, 12 April 2012, 02:57 AM
 

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)

closed-head-injuryaxon

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

StageAreas Affected
I- Parasagital region  of the frontal lobes
- Periventricular temporal lobes
- Internal dan External capsules
- Cerebellum 
IIStage I + Corpus Callosum
IIIStage I + Stage II dorsolateral quadrants of the rostral brain stem

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 injuryThe 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)


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Re: Diffuse Axonal Injury: Ethiologi, Diagnosa, And Treatment
by Ruzbih Bahtiar - Tuesday, 13 November 2012, 12:11 AM
 
Is there any surgical treatment needed?
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Re: Diffuse Axonal Injury: Ethiologi, Diagnosa, And Treatment
by dr prabudi - Tuesday, 13 November 2012, 01:50 AM
 

Diffuse axonal injuries are treated very similarly to other head injuries. In most cases, watchful waiting is the main course of treatment. Most people with diffuse axonal injuries are admitted to the hospital for observation and care. Pain associated with the head injury and other injuries sustained can be treated with painkillers like acetaminophen. 

but In some cases, brain swelling may cause extreme pressure on the skull; if this is the case, surgery may be recommended to relieve pressure.