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Case of the Week

DIFFUSE AXONAL INJURY FOLLOWING MVA

by: Emily Ament, Medical Student, University of North Dakota School of Medicine, North Dakota, USA



History: 13 year old female involved in a MVA. Ejected from vehicle and found a number of feet away. Patient was unresponsive at the scene; remained unresponsive en route & throughout her hospital course to this point

Discussion: Severe traumatic brain injury (TBI) involves two insults: the primary direct injury to brain parenchyma followed by a cascade of biochemical, cellular, and metabolic responses causing secondary damage. Hypoxemia and hypotension may also contribute to secondary injury.

TBI can either be focal or diffuse. One type of diffuse injury is diffuse axonal injury (DAI). DAI develops as the result of tissue stretching or shearing at the interface of gray and white matter. Head impact is not required for injury. Can occur in association with focal injuries. More


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