Diffuse axonal injury (DAI) is the disruption of axonal fibers in the white matter and brainstem. Shearing forces on the neurons generated by sudden deceleration cause DAI. A relationship exists between the force of sudden deceleration and the amount of DAI observed in all cases of TBI except for assaults and whiplash. The classic cause of DAI is an MVC. In infants, the "shaken baby syndrome" is a well-described tragic cause.
Injury occurs immediately and is essentially irreversible. There is a rapid or immediate increase in ICP. Patients present unresponsive. The state may be prolonged or permanent until death. A CT scan of a patient with DAI may be normal, but the classic triad demonstrates hemorrhagic injury to the corpus callosum, the midbrain or pons, and retraction of the Balls of Cajal. The treatment options for DAI are very limited, but attempt to prevent secondary damage by reducing cerebral edema.
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