Indian Journal of Neurotrauma 2011; 08(02): 71-75
DOI: 10.1016/S0973-0508(11)80003-1
Review article
Thieme Medical and Scientific Publishers Private Ltd.

Traumatic axonal injury in mild to moderate head injury — an illustrated review

S Sanjith

Subject Editor:
Further Information

Publication History

Publication Date:
05 April 2017 (online)

Abstract

Head injury forms the most common and serious form of trauma seen in India. Though data in India as a whole is sparse it does seem appropriate to say that mild to moderate head injury seems to form the major bulk of head injuries. Many such patients with normal CT scans who are discharged after a short period of ICU stay experience cognitive deficits, reduced attention spans and have problems with “executive functions” like planning, problem solving, abstract reasoning, judgment making etc. Some patients also have language deficits, problems with driving, hand eye coordination, behavioral changes and many other minor problems which may take a long time to recover. Most of these functional abnormalities are probably due to diffuse axonal injury.

Axonal injury is one of the common pathological entities in any severity of head injury and is a diagnosis of exclusion for almost all of the clinical symptoms which cannot be explained otherwise. A case has been illustrated in this regards.

The review throws light on the pathophysiology and some recent advances in imaging and treatment modalities of traumatic axonal injury due to mild to moderate head injury.

 
  • References

  • 1 Adams JH, Doyle D, Ford I, Gennarelli TA, Graham DI, McLellan DR. Diffuse axonal injury in head injury: definition, diagnosis and grading. Histopathology 1989; 15: 49-59
  • 2 Adams JH, Doyle D, Graham DI, Lawrence AE, McLellan DR. Diffuse axonal injury in head injuries caused by a fall. Lancet 1984; 02 8417–8418 1420-1422
  • 3 Blumbergs PC, Jones NR, North JB. Diffuse axonal injury in head trauma. J Neurol Neurosurg Psychiatry 1989; 52: 838-841
  • 4 Gennarelli TA, Thibault LE, Adams JH, Graham DI, Thompson CJ, Marcincin RP. Diffuse axonal injury and traumatic coma in the primate. Ann Neurol 1982; 12: 564-574
  • 5 Strich SJ. Diffuse degeneration of cerebral white matter in severe dementia following head injury. J Neurol Neurosurg Psychiatry 1956; 19: 163-185
  • 6 Strich SJ. Shearing of nerve fibres as a cause of brain damage due to head injury: a pathological study of 20 cases. Lancet 1961; 02: 443-448
  • 7 Adams JH, Graham DI, Murray LS, Scott G. Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases. Ann Neurol 1982; 12: 557-563
  • 8 Pettus EH, Christman CW, Giebel ML, Povlishock JT. Traumatically induced altered membrane permeability: its relationship to traumatically induced reactive axonal change. J Neurotrauma 1994; 11: 507-522
  • 9 Agrawal SK, Nashmi R, Fehlings MG. Role of L- and N-type calcium channels in the pathophysiology of traumatic spinal cord white matter injury. Neuroscience 2000; 99: 179-188
  • 10 Wolf JA, Stys PK, Lusardi T, Meaney D, Smith DH. Traumatic axonal injury induces calcium influx modulated by tetrodotoxin-sensitive sodium channels. J Neurosci 2001; 21: 1923-1930
  • 11 He X, Yi S, Zhang X, Fei Z. et al Intra-axonal overloading of calcium ion in rat diffuse axonal injury and therapeutic effect of calcium antagonist. Chin J Traumatol 1999; 15 (02) 25-29
  • 12 Pettus EH, Povlishock JT. Characterization of a distinct set of intra-axonal ultrastructural changes associated with traumatically induced alteration in axolemmal permeability. Brain Res 1996; 722: 1-11
  • 13 Springer JE, Nottingham SA, McEwen ML, Azbill RD, Jin Y. Caspase-3 apoptotic signaling following injury to the central nervous system. Clin Chem Lab Med 2001; 39: 299-307
  • 14 Büki A, Okonkwo DO, Wang KK, Povlishock JT. Cytochrome c release and caspase activation in traumatic axonal injury. J Neurosci 2000; 20: 2825-2834
  • 15 Singleton RH, Zhu J, Stone JR, Povlishock JT. Traumatically induced axotomy adjacent to the soma does not result in acute neuronal death. J Neurosci 2002; 22: 791-802
  • 16 Cope ND. The rehabilitation of traumatic brain injury. In: Kottke, Lehman. eds Krusen’s Handbook of Physical Medicine and Rehabilitation. W. B. Saunders; Philadelphia: 1990: 1217-1251
  • 17 Williams DH, Levin HS, Eisenberg HM. Mild head injury classification. Neurosurgery 1990; 27: 422-428
  • 18 Smith DH, Meaney DF, Shull WH. Diffuse axonal injury in head trauma. J Head Trauma Rehabil 2003; 18: 307-316
  • 19 Blumbergs PC, Scott G, Manavis J, Wainwright H, Simpson DA, McLean AJ. Topography of axonal injury as defined by amyloid precursor protein and the sector scoring method in mild and severe closed head injury. J Neurotrauma 1995; 12: 565-572
  • 20 Levi L, Guilburd JN, Lemberg A. et al Diffuse axonal injury: analysis of 100 patients with radiological signs. Neurosurgery 1990; 27: 429-432
  • 21 Mittl RL, Grossman RI, Hiehle JF. et al Prevalence of MR evidence of diffuse axonal injury in patients with mild head injury and normal head CT findings. AJNR Am J Neuroradiol 1994; 15: 1583-1589
  • 22 Inglese M, Makani S, Johnson G. et al Diffuse axonal injury in mild traumatic brain injury: a diffusion tensor imaging study. J Neurosurg 2005; 103: 298-303
  • 23 Wang H, Duan G, Zhang J, Zhou D. Clinical studies on diffuse axonal injury in patients with severe closed head injury. Chin Med J (Engl) 1998; 111: 59-62
  • 24 Chin Med J (Engl) 1998; 111: 59–62.Cordobés F, Lobato RD, Rivas JJ, Cabrera A, Sarabia M, Castro S et al. Post–traumatic diffuse axonal brain injury. Analysis of 78 patients studied with computed tomography. Acta Neurochir (Wien) 1986; 81:27-35.
  • 25 Parizel PM, Van Goethem JW, Ozsarlak O, Maes M, Phillips CD. New developments in the neuroradiological diagnosis of craniocerebral trauma. Eur Radiol 2005; 15: 569-581
  • 26 Schaefer PW, Huisman TA, Sorensen AG, Gonzalez RG, Schwamm LH. Diffusion-weighted MR imaging in closed head injury: high correlation with initial Glasgow Coma Scale score and score on modified Rankin scale at discharge. Radiology 2004; 233: 58-66
  • 27 Ashikaga R, Araki Y, Ishida O. MRI of head injury using FLAIR. Neuroradiology 1997; 39: 239-242
  • 28 Hammoud DA, Wasserman BA. Diffuse axonal injuries: pathophysiology and imaging. Neuroimaging Clin N Am 2002; 12: 205-216
  • 29 Adams JH, Doyle D, Ford I, Gennarelli TA, Graham DI, McLellan DR. Diffuse axonal injury in head injury: definition, diagnosis and grading. Histopathology 1989; 15: 49-59
  • 30 Liu AY, Maldjian JA, Bagley LJ, Sinson GP, Grossman RI. Traumatic brain injury: diffusion-weighted MR imaging findings. AJNR Am J Neuroradiol 1999; 20: 1636-1641
  • 31 Ezaki Y, Tsutsumi K, Morikawa M, Nagata I. Role of diffusionweighted magnetic resonance imaging in diffuse axonal injury. Acta Radiol 2006; 47: 733-740
  • 32 Huisman TA, Sorensen AG, Hergan K, Gonzalez RG, Schaefer PW. Diffusion-weighted imaging for the evaluation of diffuse axonal injury in closed head injury. J Comput Assist Tomogr 2003; 27: 5-11
  • 33 Arfanakis K, Haughton VM, Carew JD, Rogers BP, Dempsey RJ, Meyerand ME. Diffusion tensor MR imaging in diffuse axonal injury. AJNR Am J Neuroradiol 2002; 23: 794-802
  • 34 Le TH, Mukherjee P, Henry RG, Berman JI, Ware M, Manley GT. Diffusion tensor imaging with three-dimensional fiber tractography of traumatic axonal shearing injury: an imaging correlate for the posterior callosal “disconnection” syndrome: case report. Neurosurgery 2005; 56: 189
  • 35 Sinson G, Bagley LJ, Cecil KM. et al Magnetization transfer imaging and proton MR spectroscopy in the evaluation of axonal injury: correlation with clinical outcome after traumatic brain injury. AJNR Am J Neuroradiol 2001; 22: 143-151
  • 36 Rosa CM, Luigi B, Antonio D, Nicoletta A, Gloria L, Marco G. Early prognosis after severe traumatic brain injury with minor or absent computed tomography scan lesions. J Trauma 2011; 70: 447-451
  • 37 Merenda A, Bullock R. Clinical treatments for mitochondrial dysfunctions after brain injury. Curr Opin Crit Care 2006; 12: 90-96
  • 38 Büki A, Okonkwo DO, Povlishock JT. Postinjury cyclosporin A administration limits axonal damage and disconnection in traumatic brain injury. J Neurotrauma 1999; 16: 511-521
  • 39 Scheff SW, Sullivan PG. Cyclosporin A significantly ameliorates cortical damage following experimental traumatic brain injury in rodents. J Neurotrauma 1999; 16: 783-792
  • 40 Suehiro E, Povlishock JT. Exacerbation of traumatically induced axonal injury by rapid post-hypothermic rewarming and attenuation of axonal change by cyclosporin A. J Neurosurg 2001; 94: 493-498
  • 41 Sullivan PG, Thompson M, Scheff SW. Continuous infusion of cyclosporin A postinjury significantly ameliorates cortical damage following traumatic brain injury. Exp Neurol 2000; 161: 631-637
  • 42 Turner-Stokes L, Disler PB, Nair A, Wade DT. Multidisciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database Syst Rev 2005; (3):CD004170.
  • 43 Paterakis K, Karantanas AH, Komnos A, Volikas Z. Outcome of patients with diffuse axonal injury: the significance and prognostic value of MRI in the acute phase. J Trauma 2000; 49: 1071-1075