Diffuse axonal injury: its role in diffuse brain injury and its significance for severe disability and vegetative state

Abstract

Diffuse traumatic brain injury and combinations of diffuse with focal impact traumatic brain injury can cause widespread diffuse axonal injury (DAI) to the white matter. DAI is often the main reason for a persistent vegetative state or a persistent dementia after acute brain damage and may be responsible for a poor outcome after neurosurgical interventions. In the last few years, amyloid precursor protein (APP) has attracted interest as an early marker of DAI staining only injured axons, whereas background uninjured axons are not stained, in contrast to the more traditional demonstration of DAI by neurofilament proteins, which also stain normal axons. On the one hand, there are a number of forensic implications with regard to the evidence and the time pattern of occurrence of DAI, on the other hand, experimental studies mainly carried out by neurosurgeons in cooperation with neuropathologists provide insights into the pathobiology and the severity of DAI with regard to irreversible damage to axons and/or the time pattern of reversibility, both being of prognostic importance.