Challenges of diffuse axonal injury diagnosis

"This can't be right. Jay is in a vegetative state following a severe traumatic brain injury (TBI), but his computed tomography scan is essentially normal. How am I going to explain this to his mom?" This is a conversation I overhear among my rehabilitation nurse colleagues from time to time. Jay has a type of brain trauma called diffuse axonal injury (DAI). Recent statistics from the National Centers for Injury Prevention and Control (NCIPC, 2006) indicate 1.4 million people sustain a TBI each year in the United States. The leading causes of TBI are falls (28%), motor vehicle accidents (20%), being struck by or against an object (19%), and assaults (11%; NCIPC). DAI, one of the most important causes of cognitive dysfunction after TBI (Sugiyama et al., 2007), occurs in a more widespread pattern in certain regions of the brain than the localized zone of focal injuries. It is one of the most devastating forms of TBI and a common cause of vegetative state and severe disability. DAI occurs in 40%-50% of all patients who are hospitalized from TBI (Meythaler, Peduzzi, Eleftheriou, & Novack, 2001).