Diffuse axonal brain injury
Last reviewed: 23.04.2024
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The term "diffuse axonal brain damage" was first proposed in 1982 by JH Adams, and pathology itself as a separate form of craniocerebral trauma was first described in 1956 by SJ Strich, who observed patients who were and vegetative status. This type of injury occurs as a result of rotational acceleration-deceleration, which happens with inertial types of trauma. This leads to complete or partial injuries (tearing) of axons, often associated with small focal hemorrhage. In most cases, such changes in brain tissue occur on sites with a maximum difference in brain tissue density - at the border of gray and white matter in the brain.
[Symptoms of diffuse axonal injury
Diffuse axonal brain damage is characterized by a prolonged coma that occurs immediately after a trauma without a clear interval, symmetrical or asymmetric symptoms of decorticization, often the variability of muscle tone changes (from diffuse muscle hypotension to hormoneotomy), gross stem symptoms, meningeal syndrome. With diffuse axonal brain damage, gross violations of vital functions are almost always observed, as well as pronounced vegetative changes. The coma is most often transformed into a trance and a torous or persistent vegetative state, in the event of a withdrawal from which remain rough symptoms of prolapse (usually extrapyramidal symptoms and severe psychiatric disorders predominate).
Diagnosis of diffuse axonal injury
Diagnosis of diffuse axonal injury is based on the account of the biomechanics of craniocerebral trauma. The coma that occurred immediately after CCT, with severe impairment of stem functions, generalized tonic reactions, symptomatic of symmetrical or asymmetric decorticization (decortication), suggests that it is diffuse axonal brain damage.
For a computer tomogram of the brain with diffuse axonal brain damage, an increase in the brain volume due to its edema, swelling, hyperemia with compressed ventricles of the brain and subarach podal convective spaces is characteristic. In this case, small-focal hemorrhages in the white substance of the cerebral hemispheres, the corpus callosum, and also in the subcortical and stem structures are often identified.
MRI reveals changes that depend on the presence or absence of hemorrhage and their prescription. A frequent finding of MRI examinations in diffuse axonal brain damage is shallow-focal hemorrhages in deep structures sub-iendimarno. Over time, the intensity of the image of these foci is reduced.
Treatment of diffuse axonal injury
Affected people with diffuse axial injury are not subject to surgical treatment. Indications for surgery for diffuse axonal brain damage occur only when there are concomitant focal lesions that cause brain pressure. Conservative treatment is carried out in intensive care units.
Affected people who have diffuse axonal brain damage require prolonged ventilation in the mode of hyperventilation with a set of therapeutic measures aimed at maintaining metabolic processes using enteral and parenteral nutrition, correcting violations of acid-base and water-electrolyte balance, normalizing osmotic and colloidal composition blood, the system of homeostasis. To prevent and treat infectious and inflammatory complications, antibacterial drugs are prescribed taking into account the sensitivity of the microflora.