Diagnosis of Diffuse Axonal Injury after Head Trauma

Overview

The clinical diagnosis of diffizse axonal injury - DAI - is difficult because this damage of the white matter is as a rule combined with other traumatic changes. Basic symptoms include protracted unconsciousness, in more severe cases decortication or decerebration rigidity, other brain stem symptoms and symptoms of lesions of the corpus callosum. Later neuropsychological disorders persist. The authors evaluate the contribution of EEG in the diagnosis of DAI. The decisive method for diagnosis is magnetic resonance. CT examination usually does not detect DAI. Suspicion may be however aroused by a neurologckkl finding which has no correlate in CT. The diagnosis of DAI can be confirmed unequivocally only on p.m. by histological examination of tissue samples collected from typically affected areas. The latter include the corpus callosum, parasagittal subcortical white matter, capsula interna and the rostral area of the brain stem. Most sensitive is the immunocytochemical examination of the *beta-amyloid precursor protein the pozitivity of which in damaged axons is usually detected already during survival two hours after the injury.

Key words:
diffizse axonal injury - clinical diagnosis - morphological diagnosis - magnetic resonance - *beta-amyloid precursor protein.