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Diffuse axonal damage to the brain
Last reviewed: 07.07.2025
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The term "diffuse axonal brain injury" was first proposed in 1982 by JH Adams, and the pathology itself as a separate form of craniocerebral trauma was first described in 1956 by SJ Strich, who observed patients in a vegetative state. This type of injury occurs as a result of rotational acceleration-deceleration, which occurs with inertial types of injury. This leads to complete or partial damage (ruptures) of axons, often combined with small focal hemorrhages. In most cases, such changes in brain tissue occur in areas with the maximum difference in brain tissue density - at the border of the gray and white matter of the brain.
[ Symptoms of diffuse axonal injury
Diffuse axonal damage to the brain is characterized by a prolonged comatose state that occurs immediately after the injury without a lucid interval, symmetrical or asymmetrical symptoms of decerebration (decortication), often - variability of changes in muscle tone (from diffuse muscle hypotonia to hormeotonia), severe stem symptoms, meningeal syndrome. With diffuse axonal damage to the brain, severe disturbances of vital functions are almost always observed, as well as pronounced vegetative changes. Coma most often transforms into a transient or persistent vegetative state, in the event of recovery from which severe symptoms of loss remain (usually extrapyramidal symptoms and severe mental disorders dominate).
Diagnosis of diffuse axonal injury
The diagnosis of diffuse axonal injury is based on taking into account the biomechanics of traumatic brain injury. A comatose state that occurs immediately after TBI, with pronounced impairments of brain stem functions, generalized tonic reactions, symptoms of symmetrical or asymmetrical decerebration (decortication) gives grounds to assume diffuse axonal injury to the brain.
A CT scan of the brain in diffuse axonal damage of the brain is characterized by an increase in brain volume due to its edema, swelling, hyperemia with compression of the cerebral ventricles and subarachnoid convexital spaces. In this case, small focal hemorrhages are often detected in the white matter of the cerebral hemispheres, the corpus callosum, as well as in the subcortical and stem structures.
MRI reveals changes depending on the presence or absence of hemorrhages and their duration. A frequent finding of MRI examinations in diffuse axonal damage of the brain are small focal hemorrhages in deep structures sub-endymally. Over time, the intensity of the image of these foci decreases.
Treatment of diffuse axonal injury
Victims with diffuse axonal injury are not subject to surgical treatment. Indications for surgery for diffuse axonal brain injury arise only when concomitant focal lesions causing pressure on the brain are detected. Conservative treatment is carried out in intensive care units.
Victims with diffuse axonal brain injury require long-term artificial ventilation in hyperventilation mode with a set of therapeutic measures aimed at maintaining metabolic processes using enteral and parenteral nutrition, correcting acid-base and water-electrolyte balance disorders, normalizing the osmotic and colloidal composition of the blood, and the homeostasis system. Antibacterial drugs are prescribed for the prevention and treatment of infectious and inflammatory complications, taking into account the sensitivity of the microflora.