Diffuse axonal injury - an interdisciplinary problem. Current knowledge and two case reports.

Area of Science:

• Neurology
• Trauma Medicine

Background:

• Diffuse axonal injury (DAI) is a common consequence of traumatic brain injury (TBI), particularly from acceleration-deceleration events.
• DAI involves widespread microscopic damage to axons, often leading to significant cognitive and behavioral deficits.

Observation:

• Two cases of DAI following traffic accidents are presented.
• Patients exhibited memory deficits (amnesia), attention deficits, confusion, and lack of insight into their condition.
• Initial CT scans revealed brain edema, petechiae, subarachnoid hemorrhage, and fractures, but lacked specific DAI markers.

Findings:

• DAI should be suspected in traffic accident survivors presenting with behavioral changes, amnestic syndrome, and minimal focal neurological signs.
• The subtle nature of DAI necessitates a high index of suspicion, especially when initial imaging is non-specific.

Implications:

• Early recognition of DAI is crucial for appropriate patient management and prognosis.
• This highlights the importance of thorough psychiatric and neurological evaluation in trauma patients with unexplained cognitive and behavioral symptoms.
• Further research into sensitive diagnostic markers for DAI is warranted.