Diffuse Axonal Injury and Status Epilepticus

Year 2024, Volume: 15 Issue: 3, 63 - 65, 22.09.2024

Yasin Ugur , Ayse Busra Ozcan

https://doi.org/10.33706/jemcr.1498661

Abstract

Introduction: Diffuse axonal injury (DAI), microscopic damage to axons in the brain neural pathways, corpus callosum, and brain stem, is associated with significant mortality and morbidity. The treatment of patients with DAI is geared towards preventing secondary injuries and facilitating rehabilitation.
Case Report: A 57-year-old male patient was brought to the emergency room by the EMS team with the complaint of seizures in the form of an incision on the scalp, change in consciousness, confusion and convulsions after he lost his head to a cutting tool at work. In his neurological examination, it was found that the pupils were isochoric, the patient had seizures repetitively every two minutes, his consciousness was confused, and he could not obey orders. The patient was intubated with the diagnosis of status epilepticus due to diffuse axonal damage after a sharp object injury and was followed up in the intensive care unit. The patient improved clinically after the intensive care unit and was discharged with a follow-up recommendation.
Conclusion: The possibility of diffuse axonal damage due to the mechanism of the trauma should be considered in cases that are not of high severity and no etiology has been detected and presenting with post-traumatic unconsciousness.

Keywords

Diffuse Axonal Injury, Trauma, Seizure

References

• 1. Ekmekyapar T. The effects of systemic inflammatory indices, lactate, and blood gas parameters on drug-resistant and drug-nonresistant epilepsy. J Exp Clin Med 2023; 40(3): 640- 645
• 2. Gennarelli TA. Cerebral concussion and diffuse brain injuries. 2nd ed. In: Cooper PR, editor. Head Injury. Baltimore: Williams & Wilkins (1987). p. 108–24.
• 3. Gennarelli TA. Cerebral concussion and diffuse brain injuries. 3rd ed. In: Cooper PR, editor. Head Injury. Baltimore: Williams & Wilkins (1993). p. 137–58.
• 4. Lagares A, Ramos A, Alday R, Ballenilla F, Pérez-Nuñez A, Arrese I, et al. Magnetic resonance in moderate and severe head injury: comparative study of CT and MR findings. Characteristics related to the presence and location of diffuse axonal injury in MR. Neurocirugia (Astur) (2006) 17(2):105– 18. doi:10.1016/S1130-1473(06)70351-7
• 5. Moen KG, Skandsen T, Folvik M, Brezova V, Kvistad KA, Rydland J, et al. A longitudinal MRI study of traumatic axonal injury in patients with moderate and severe traumatic brain injury. J Neurol Neurosurg Psychiatry (2012) 83(12):1193– 200. doi:10.1136/jnnp-2012-302644
• 6. 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(1):58–66. doi:10.1148/radiol.2323031173.
• 7. Fassil B. Mesfin, Nishant Gupta, Angela Hays Shapshak, Roger S. Taylor. Diffuse Axonal Injury. StatPearls Publishing. July 26, 2021.
• 8. Adams JH, Graham DI, Gennarelli TA. Head injury in manand experimental animals: neuropathology. Acta Neurochir Suppl (Wien). 1983;32:15– 30.
• 9. Graham DI, McLellan D, Adams JH, Doyle D, Kerr A, Murray LS. The neuropathology of the vegetative state and severe disability after non-missile head injury. Acta Neurochir Suppl (Wien). 1983;32:65– 67.
• 10. Meythaler JM, Peduzzi JD, Eleftheriou E, Novack TA. Current concepts: diffuse axonal injury-associated traumatic brain injury. Arch Phys Med Rehabil 2001; 82(10):1461–71.
• 11. Humble SS, Wilson LD, Wang L, Long Da, Smith MA, Siktberg JC, et al. Prognosis of diffuse axonal injury with traumatic brain injury. J Trauma Acute Care Surg 2018; 85(1):155–9
• 12. Sandhu S, Soule E, Fiester P,Natter P, Tavanaiepour D, Rahmathulla G, et al. Brain stem diffuse axonal injury and consciousness. J Clin Imaging Sci 2019; 9(6):32.
• 13. Moe HK, Myhr JL, Moen KG,Haberg AK, Skandsen T, Vik A.Association of cause of injury and traumatic axonal injury: a clinical MRI study of moderate and severe traumatic brain injury. J Neurosurg 2019; 11(10):1-9.
• 14. Adams JH, Doyle D, Ford I, Genneralli TA, Graham DI, Mc Lellan DR. Diffuse axonal injury in head injury: Definition, diagnosis and grading. Histopathology 1989; 15:49–59.
• 15. Tsitsopoulos PP, Hamdeh SA, Marklund N. Curren topportunities for clinical monitoring of axonal pathology in traumatic brain injury. Front Neurol 2017; 8:599.
• 16. Gentry LR, Godersky JC, Thompson B. MR imaging of head trauma: review of the distribution and radiopathologic features of traumatic lesions. AJR Am J Roentgenol 1988; 150:663–72.