Abstract
Meythaler JM, Peduzzi JD, Eleftheriou E, Novack TA. Current concepts: diffuse axonal
injury–associated traumatic brain injury. Arch Phys Med Rehabil 2001;82:1461-71. Objectives: To review the probable physical, physiologic mechanisms that result in the medical
and neuropsychologic complications of diffuse axonal injury (DAI)–associated traumatic
brain injury (TBI). Data Sources: Various materials were accessed: MEDLINE, textbooks, scientific presentations, and
current ongoing research that has been recently reported. Study Selection: Included were scientific studies involving TBI, particularly direct injury to the
axons and glia of the central nervous system (CNS) in both in vitro and in vivo models.
These studies include pathologic findings in humans as well as the medical complications
and behavioral outcomes of DAI. Studies that addressed animal models of DAI as well
as cellular and/or tissue models of neuronal injury were emphasized. The review also
covered work on the physical properties of materials involved in the transmission
of energy associated with prolonged acceleration-deceleration injuries. Data Extraction:Studies were selected with regard to those that addressed the mechanism of TBI associated
with DAI and direct injury to the axon within the CNS. The material was generally
the emphasis of the article and was extracted by multiple observers. Studies that
correlate the above findings with the clinical picture of DAI were included. Data Synthesis: Concepts were developed by the authors based on the current scientific findings and
theories of DAI. The synthesis of these concepts involves expertise in physical science,
basic science concepts of cellular injury to the CNS, acute medical indicators of
DAI, neuropsychologic indicators of DAI, and rehabilitation outcomes from TBI. Conclusions: The term DAI is a misnomer. It is not a diffuse injury to the whole brain, rather
it is predominant in discrete regions of the brain following high-speed, long-duration
deceleration injuries. DAI is a consistent feature of TBI from transportation-related
injuries as well as some sports injuries. The pathology of DAI in humans is characterized
histologically by widespread damage to the axons of the brainstem, parasagittal white
matter of the cerebral cortex, corpus callosum, and the gray-white matter junctions
of the cerebral cortex. Computed tomography and magnetic resonance imaging scans taken
initially after injury are often normal. The deformation of the brain due to plastic
flow of the neural structures associated with DAI explains the micropathologic findings,
radiologic findings, and medical and neuropsychologic complications from this type
of injury mechanism. There is evidence that the types of cellular injury in TBI (DAI,
anoxic, contusion, hemorrhagic, perfusion-reperfusion) should be differentiated, as
all may involve different receptors and biochemical pathways that impact recovery.
These differing mechanisms of cellular injury involving specific biochemical pathways
and locations of injury may, in part, explain the lack of success in drug trials to
ameliorate TBI. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy
of Physical Medicine and Rehabilitation
Keywords
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Article info
Publication history
Accepted:
November 9,
2000
Received in revised form:
November 9,
2000
Footnotes
☆Supported in part by the Centers for Disease Control and Prevention–National Center for Injury Prevention and Control, US Department of Health and Human Services (grant no. R49/CCR403641-11) and the National Institute of Disability and Rehabilitation Research, US Department of Education, Traumatic Brain Injury Model Systems (grant no. H133A980010).
☆☆No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.
★Reprint requests to Jay M. Meythaler, MD, JD, University of Alabama at Birmingham, R157 Spain Rehabilitation Ctr, 619 19th St S, Birmingham, AL 35249-7330, e-mail: [email protected]
Identification
Copyright
© 2001 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
