Diffuse axonal injury: its mechanism in an assault case

Diffuse axonal injury is caused by irreparable shearing of the axons. A case of diffuse axonal injury by a well-witnessed assault is reported. The victim survived for 13 days after the assault. The mode of assault was numerous kicks to the head of the victim lying on the ground. The kicking motion was sideways across the long axis of the body. Thus, on each impact, the victim's head moved with relative freedom or was tossed violently side to side or in a lateral, even angular or rotational, manner. This resulted in a low acceleration/deceleration rate. Grossly, the brain showed no lesions; however, a microscopic lytic lesion was present in the corpus callosum. These injuries were consistent with a grade-2 diffuse axonal injury (Adams classification).