Diffuse Axonal Injury: A Devastating Pathology

Abstract

Traumatic brain injury (TBI) also known as intracranial injury is the result of a lesion within the brain due to an external force. Common forms of TBI result from falls, violence, and/or vehicle crashes; the classification of this pathology is dependent on the severity of the lesion as well as the mechanism of trauma to the head. One of the most common onsets of traumatic brain injuries result from mild to severe lesions to the white matter tracts of the brain called diffuse axonal injury (DAI); however, additional forms of TBI's can present in non-penetrating forms. Penetrating forms of TBI's such as trauma to the head via a foreign object do also contribute to the many millions of TBI cases per year, but we will not discuss these traumatic injuries as in depth within this chapter. The onset of diffuse axonal injury will vary on a per-patient basis from mild to severe, based on a standardized neurological examination rated on the Glasgow Coma Scale (GCS), which indicates the severity of brain damage present. While there is a spectrum of severity for DAI patients, a concussion is typically observed within a larger majority of patients in addition to other overwhelming trauma.

Diffuse Axonal Injury dan Temuannya

“…Substansia alba terdiri dari beberapa berkas akson bermielin. 12 Lesi pada substansia alba paling sering memengaruhi lobus frontal dan temporal, namun dapat juga memengaruhi bagian otak lainnya seperti korpus kalosum dan batang otak. 13 Pada saat terjadi trauma pada otak, langsung terjadi kerusakan dan diskontinuitas akson pada situs impaksi.…”

“…1 Penyebab DAI antara lain kecelakaan lalu lintas, cedera olahraga, kekerasan, dan jatuh. 12 Kondisi DAI umumnya terjadi setelah ada akselerasi kepala yang terjadi secara gradual dalam rentang waktu yang cukup panjang. 1 Pergerakan akselerasi dan deselerasi menyebabkan gaya regang, gaya geser, atau gaya rotasional terhadap substansia alba di otak sehingga menyebabkan cedera aksonal difus.…”

Clinical practice in occupational therapy for treatment of concussion in schoolboys: An integrative review

“…Diffuse axonal injury is a form of injury which may occur as a result of concussion. These changes are seen within the white matter of the brain tissue and can result in altered die-back disconnection (early degenerative events in the injured neurons) and reorganisation of axons 29,30 . This results in long-term implications and more severe effects particularly to white matter unmyelinated fibres that are found in the developing brain 29 .…”

“…This results in long-term implications and more severe effects particularly to white matter unmyelinated fibres that are found in the developing brain 29 . Any disruption of this process due to injury can have consequences for the development and consolidation of cognitive skills such as decision making and problem solving 5,29,30 .…”