What Is Diffuse Axonal Injury? Colorado Springs Accidents

Diffuse Axonal Injury

Written by Jeremy D. Earle, JD

July 24, 2022


Diffuse axonal damage is one of the most prevalent types of traumatic brain injury (DAI). It is caused by the brain moving back and forth quickly inside the skull, not by a blow to the head. The brain’s abrupt  acceleration or deceleration might cause damage to a large or “diffuse” region. It is a primary cause of  mortality in traumatic brain injury patients, even though it occurs in varying degrees of severity.

Car and motorcycle accidents, shaken infant syndrome, falls, and sports are prominent causes of diffuse axonal damage. The component of the brain’s nerve cells known as axons is torn from tissue sliding over tissue as the brain quickly accelerates or decelerates inside the skull.

The formation of lesions causes  unconsciousness. Brain cells may die, causing swelling in the brain. As a consequence of the increased  pressure, blood flow may be reduced, potentially leading to further damage.

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The most common sign of diffuse axonal damage is unconsciousness that lasts several hours or longer. Depending on the location of the brain where the injury occurred, other symptoms may appear even in  moderate instances.

Magnetic Resource Imaging (MRI) CT Scan, Evoked Potentials, which look at the visual, sensory, and auditory routes to the brain, and Electroencephalogram are all used to identify the disorder. (EEG) The EEG is a device that monitors the electrical activity of the brain.


A person who has suffered diffuse axonal damage is not a surgical candidate. The objective of therapy is to stabilize the patient by reducing swelling within the body and preventing additional injury.

In most situations, steroid or anti-inflammatory medicines are utilized to treat diffuse axonal damage. Once the patient is stabilized, this treatment is followed by rehabilitation.

A traumatic brain recovery program with a team of physicians, nurses, and specialists, including occupational, physical, speech, and recreational therapists, is required for rehabilitation. Counseling should be part of the rehabilitation process.


In severe instances of diffuse axonal damage, the prognosis is poor. Approximately 90% of survivors  never recover consciousness, with the other 10% suffering permanent injury and handicap. Physical, mental, and emotional injury may range from minor to life-altering in mild to severe instances. The long- term consequences may not be realized until later in life. It is essential to budget for years of therapy to heal.

Due to physical and mental restrictions, a person with diffuse axonal injury may not work in their  desired job or perhaps work at all. This may lead to a loss of income throughout a person’s life and the  additional expenditure of long-term medical bills such as treatment and rehabilitation.


A person may never recoup their financial losses or be fully compensated for future losses, pain, and suffering, or a reduced lifestyle without the assistance of a suitably qualified and professional personal injury legal company.

Many untrained or inadequate lawyers may advise their diffuse axonal injury clients to accept a much less than acceptable payment. They are satisfied with their % for processing the issue and do not consider the client’s long-term impact.

Throughout a lifetime, a loss of income may amount to millions of dollars. The total quickly rises when you include in the costs of experts, medicine,  rehabilitation, and therapy.

An expert brain injury lawyer will actively seek the appropriate payout, taking all losses and suffering into account. The correct legal company will have the financial means to  pay for accident reconstruction experts and occupational therapists to assist your case.


Diffuse axonal injury (DAI), commonly referred to as traumatic axonal injury (TAI), is a severe kind of traumatic brain damage caused by shearing forces. It’s a challenging diagnosis to establish based on imaging alone, particularly on CT, since the finding may be modest, yet it can lead to significant neurological damage.

The diagnosis is best established with an MRI, which shows multiple tiny areas of susceptibility artifact  at the grey-white matter junction, in the corpus callosum, and in more severe instances, in the brainstem, all surrounded by FLAIR hyperintensity.


Patients at risk of diffuse axonal damage are in the same group as those with a traumatic brain injury.  Therefore young males are overrepresented.

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Patients with diffuse axonal damage often experience loss of consciousness at the moment of the trauma. Post-traumatic coma may persist for a long time and is usually caused by more obvious damage (e.g., cerebral contusions). As a result, the diagnosis is often overlooked until patients do not improve neurologically as predicted.


Shearing due to change in velocity preference axons at the grey-white matter junction, as the name  indicates, owing to the somewhat differing specific gravities (relative mass per unit volume) of white and grey matter. Shearing forces, usually from rotational acceleration, cause diffuse axonal damage (most  often a deceleration).

The bulk of the time, these stresses injure the cells, resulting in edema. Only in the  most severe instances do the axons completely rupture. It’s also known that specific neurons might degenerate in the weeks or months after damage, a condition known as secondary axonotmesis.


Multiple focal lesions with a particular distribution describe diffuse axonal damage, which is often seen  at the grey-white matter junction, in the corpus callosum, and more severe instances, in the brainstem (see: grading of diffuse axonal injury).

In patients with head traumas, a non-contrast CT scan of the brain is standard. Unfortunately, it is not sensitive to mild diffuse axonal damage. Therefore some individuals with otherwise regular CT scans may have significant neurological deficits.

The appearance is determined by whether the lesions are hemorrhagic or not. Hyperdense hemorrhagic lesions vary in size from a few millimeters to a few centimeters in diameter. Lesions that are not hemorrhagic are hypodense. As edema forms surrounding them, they usually grow more visible throughout the first several days. They may be linked to a large and disproportionate amount of cerebral edema.

CT is incredibly insensitive to non-hemorrhagic lesions (as defined by CT), only detecting 19% of them compared to 92% with T2 weighted imaging4. CT is quite sensitive when lesions are hemorrhagic and  mainly when they are significant. As a result, it’s typically reasonable to assume that the damage is substantially worse if a few tiny hemorrhagic lesions are evident on CT.

Even in individuals with entirely regular brain CT scans, MRI is the modality of choice for diagnosing suspected diffuse axonal damage. Small areas of susceptibility artifact may be seen on MRI near the  grey-white matter junction, in the corpus callosum, or the brain stem, mainly when using SWI or GRE sequences, which are very sensitive to paramagnetic blood products. Some lesions may be completely  non-hemorrhagic (even using high field strength SWI sequences). However, they will be apparent in  areas with a lot of FLAIR signals.

The degree of surrounding edema will typically grow during the first few days, but by three months after the accident, FLAIR alterations will have mostly healed. SWI alterations, on the other hand, will generally take longer to resolve, however by 12-months after the injury, there will have been significant resolution . This is to be anticipated, given that edema heals quicker than bleeding.

There is increased brain volume decline in the months after the trauma, which may sometimes be recognized by ocular examination but sometimes only by volumetric studies8.

It’s worth noting that, even with today’s high field strength scanners, the lack of evidence does not rule  out the possibility of axonal damage.

MR spectroscopy MRS may help detect individuals who have grade I damage that isn’t seen on other sequences. Choline peak elevation and NAA3 decrease are common characteristics.


Unfortunately, for individuals with diffuse axonal injury, little can be done other than providing supportive care and attempting to reduce additional damage caused by cerebral edema, hypoxia, seizures, and other factors. Neurosurgical problems such as herniation and hydrocephalus must be identified and treated as soon as possible.

Patients might range from little affected to being in a prolonged vegetative state, depending on the  degree and distribution of damage (see: grading of diffuse axonal injury). 1. Axonal damage in the brainstem predicts a long-term vegetative state, but supratentorial injury may cause localized neurological or behavioral abnormalities. 1.

Over the years, Warrior Car Accident Lawyers, has successfully secured significant financial settlements for several clients who have suffered from traumatic brain injuries of various types, including diffuse axonal injury.

We are aware of the long-term consequences of our actions. A significant brain injury is accompanied by emotional, mental, and physical problems, and we will fight to collect every penny for our clients’ suffering.

We’re here to provide you or a loved one with a free consultation  and assessment. Simply call our offices to talk with a knowledgeable brain injury attorney. You will not be charged anything until we have recovered the money you are owed. Our phone number is 719-300- 1100.

Warrior Personal Injury Lawyers
1902 W. Colorado Ave., Ste. 100
Colorado Springs, CO 80904

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