Diffuse Axonal Injury
(DAI) (also called shear injury), one of the most frequent types of primary injury that can be seen in patients with severe head trauma (see brain injury traumatic). It occurs in about 50% of all head trauma cases and it is characterized clinically by loss of consciousness starting at the moment of impact.
Pathologically multiple, bilateral, small, focal lesions thoughout the white matter, mainly at the greywhite junction, are seen.
The lesions are located in three characteristic areas: corpus callosum, brain stem (in particular the dorsolateral region and the cerebral peduncle), and lobar white matter (frontal and temporal). Corpus callosum lesions are located mainly in the posterior body and splenium; occasionally the entire corpus callosum is involved.
The pathophysiology and dynamic mechanisms that lead to this type of lesion are still uncertain. Current opinion is that corpus callosum injury is mediated by rotationally induced shear-strain forces and/or impact against the free margin of the falx. In patients with mild rotational accelerations/decelerations the lesions may be confined to the white matter of frontal and temporal lobes at the grey/white matter junction due to different inertial response of the two components with disruption of axons from the neuronal cell bodies.
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