Diffuse Axonal Brain Injuries

Car AccidentAt Miller & Zois we frequently handle personal injury cases involving all types of traumatic brain injuries. Whether they result from a car accident or medical malpractice, brain injuries are always very serious.

What Does Axonal Mean?

DAI falls under the category of diffuse brain injury. A diffuse brain injury involves brain damage that occurs over a wide area instead of one specific location. The term "axonal" refers to the axons (nerve fibers) that are connected to neurons in the brain. Axons are critical to brain function as they are the primary transmission of electrical impulses that control almost every system in the body. When the axons are damaged in some way, it disrupts the transmission of those electrical signals, which can limit or completely restrict the brain's overall functioning.

What is a Diffuse Axonal Injury?

Brain injuries are either focal or diffuse. Focal is a localized injury, often a contusion on the surface of the brain. Usually, a blow to the head is the source of a focal injury. Diffuse axonal injury is the hallmark pathology in closed head injury and is not visible on conventional MRI imaging in less severe cases.

A diffuse axonal injury is the consequence of acceleration or deceleration of the head. This causes deformations of the brain substance leading to shear injury of the brain's delicate white matter. Many head injuries are both focal and diffuse axonal injury.

A diffuse axonal injury (DAI) occurs when the connective nerve fibers (axons) in the brain are sheared or torn when the brain bounces around inside the skull during a traumatic impact. A diffuse axonal injury is one of the most serious and deadly types of traumatic brain injuries resulting in damage to numerous parts of the brain. DAI injury frequently results in a coma or persistent vegetative state.

What Causes Diffuse Axonal Injury?

DAI usually develops after some type of trauma to the head, but the damage is not actually from the physical trauma itself. The axonal injury comes as a result of the brain rapidly shifting back and forth in the skull from acceleration or deceleration. When the brain is moving too much in the skull, the axons in the neurons become disrupted.

The movement causes the brain tissue to slide over other tissue and result in what's called a shearing injury. The shearing makes lesions on the brain, meaning the tissue has become abnormal, damaged, or inflamed. If the tissue is damaged, brain cells die, which causes the brain to become even more swollen. The pressure can decrease blood flow to the brain and therefore increase the amount of brain damage or cause a stroke.

Some common traumas that can cause a diffuse axonal injury include

What are the Grades of Diffuse Axonal Injury?

Diffuse axonal injuries are separated into three different grades. This is referred to as The Adams classification. This classification is based on the severity and locations of the brain damage from injury.

  • Grade 1: This is the mildest form of DAI. It's characterized by microscopic changes in the white matter of the cerebral cortex, corpus callosum, brain stem, and cerebellum
  • Grade 2: This is considered a moderate form of DAI. In this grade, there are grossly evident focal lesions isolated to the corpus callosum.
  • Grade 3: This is the most severe form of DAI. With grade 3, there are additional focal lesions on the brainstem.
What are the Symptoms of Diffuse Axonal Injury?

The primary symptom for most people with DAI is loss of consciousness. Depending on how severe the damage is, this can last for six or more hours. People with minor DAI may remain conscious after the injury but will still experience other symptoms of brain damage. The symptoms of DAI can vary widely since each injury is unique and different parts of the brain can be affected. Some common signs of brain damage include

  • Disorientation or confusion
  • Throbbing headache
  • Nausea and vomiting
  • Fatigue
  • Difficulty sleeping or sleeping longer than usual
  • Dizziness
  • Lack of balance and coordination
How is Diffuse Axonal Injury Diagnosed?

Diagnosing a DAI can be difficult since most patients with this condition are unconscious and cannot provide the doctor with information about how the injury occurred or what symptoms they are experiencing. Doctors usually rely on certain tests to determine whether a person has a DAI.

  • Magnetic Resonance Imaging (MRI): This is the most preferred method of testing for DAI. The machine uses magnets, radio waves, and a computer screen to show a detailed image of the brain.
  • CT Scan: Somewhat similar to an MRI, this test involves using an x-ray machine and a computer screen to make a detailed image of the brain. CT scans can be less reliable than an MRI, as it can sometimes result in false negatives, so additional tests are often used to confirm the diagnosis.
  • Evoked Potentials: This test is also referred to as the SSEP, BAER, and VEP. It tests and analyzes the visual, auditory, and sensory pathways in their brain to see how the brain is functioning.
  • Electroencephalogram (EEG): This is a test that can measure the amount of electrical activity occurring in the brain.
Can You Recover From Diffuse Axonal Injury?

Diffuse axonal injuries require immediate treatment to help prevent any additional damage to the brain. Often the first step in the process is taking measures to reduce swelling inside the brain. Steroids or other anti-inflammatory drugs are used to mitigate inflammation. Unfortunately, there is no surgery available that can fix a DAI as it's nearly impossible to re-connect disrupted nerve fibers and restore dead brain cells. If the person has sustained a minor or moderate axonal injury, they will need to go through intense rehabilitation once they have regained consciousness and their condition has stabilized.

Rehabilitation for DAI usually involves a multidisciplinary team of doctors that can create an individualized recovery plan that works to address the patient's specific needs. This team is made up of doctors, brain injury specialists, nurses, counselors, and physical and occupational therapists. The goal of treatment is to try and restore as much brain function as possible to help the patient return to a normal life. It can take months or even years for treatment to be completed. Rehabilitation treatments often include

  • Speech therapy
  • Physical therapy
  • Occupational therapy
  • Recreational therapy
  • Adaptive equipment training
  • Counseling

For severe cases of DAI, a person may not be able to recover. Many people with this condition stay in a coma or vegetative-like state. If they do regain consciousness, they are often left with long-term complications.

Are Diffuse Axonal Injuries Curable or Reversible?

Once someone suffers from a DAI, it cannot ever be truly "cured" because there is no way to restore dead brain cells or nerve fiber connections. People with this condition will most likely deal with lingering complications for the rest of their life. As far as whether the condition is "reversible", there is no clear cut answer.

Each case of DAI is different, and recovery depends on different factors, such as the severity of the damage, location of the damage, and which symptoms are present. People with minor axonal injuries may be able to recover from some of the damage or at least mitigate complications associated with the injury. Severe cases of DAI most likely will not improve, especially if the person has fallen into a coma for an extended period.

What is the Prognosis for Diffuse Axonal Injuries?

The prognosis for diffuse axonal injuries is generally poor. Many people are not able to survive a severe head injury. About 90% of survivors from DAI will remain unconscious or in a vegetative-like state. For the 10% that do become conscious again, most will experience severe and permanent impairments. In the case of very minor DAI, full recovery is possible for a small number of people.

What Types of Accidents can Cause Diffuse Axonal Injury?

Diffuse axonal injury (sometimes called a "shearing" injury) occurs when the brain is violently thrust forward and backward impacting the inside of skull cavity. This occurs when the head rapidly accelerates and/or decelerates in response to an external force such as whiplash in a vehicle collision. Direct impact on the head not necessary for DAI to occur. High-impact car accidents are by far the most frequent cause of diffuse axonal brain injuries. But diffuse axonal injury can also be caused by blunt force impacts to the head in a fall, assault or other accident.

Settlements & Verdicts for Diffuse Axonal Brain Injuries

Below is a summary of the underlying facts in recent verdicts and reported settlements from cases involving a diffuse axonal brain injury. These should be used for informational purposes only as all cases are unique.

  • Plaintiff v Defendant Property Manager (New York 2018) $3 million: Plaintiff, 28-year old marketing associate, was hit in the head by a heavy ceiling tile that fell from the ceiling of an office building. Initially his head injury appeared to be minor but it was later found that he suffered diffuse axonal shearing. The injury left him with permanent cognitive disabilities preventing him from working.

  • Clarke v Austin (New York 2017) $50,000: Defendant driver hit an 8-year old pedestrian with his vehicle at a busy intersection. The impact caused the boy to suffer diffuse axonal brain injury of moderate severity. The case settled for $50,000. Why so little? This was the limit under defendant's insurance policy.

  • KD Pro Ami v State Farm (California 2017) $125,000: Plaintiff (13 years old) was crossing the street on his skateboard when he was run over at low speed by the defendant - a teenage driver making a left turn. Plaintiff suffered diffuse axonal injury and was unconscious for an extended period of time. He also fractured his hip and lost several teeth. The case settled for full policy limits of $125,000.

  • Moore v State of California (California 2017) $59.2 million: The primary plaintiff was a 20-year old road excavation worker who was run over at a highway jobsite. He suffered severe diffuse axonal brain injury leaving him in a permanent vegetative state. He sued the California Department of Transportation (CDOT) for negligently failing to control traffic and ensure safety at the road work site. His co-worker who nearly got hit and witnessed the event also sued for emotional distress. A jury in Humbolt County found CDOT 100% liable and awarded $59.2 million in damages.

  • Rogers v Major (New York 2014) $100,000: Plaintiff, a 22-year old college student, was walking across city intersection when he was hit by the defendant in his car. Plaintiff suffered a diffuse axonal injury resulting in significant mental impairment. The case settled for policy limits.

  • Chadiez v Garfara Transport (California 2012) $1 million: Plaintiff lost control of her car on a highway and after coming to a stop she was rear ended by the defendant driving a large tractor trailer truck. Plaintiff suffered a diffuse axonal injury with intracranial hemorrhaging. She also fractured several ribs. The case settled for the truck company's policy limits.

  • Neidinger v American Mutual Ins. (Wisconsin 2010) $1.1 million: Plaintiff was jogging on a sidewalk when she was hit from behind by a 2000 Chevy Impala. The impact caused scattered diffuse axonal injury to her brain. She also suffered an AC shoulder tear, dislocated knee, and other injuries. The case was settled after a pre-trial settlement conference.

  • Scrodin v Redwood Fire & Casualty Co (California 2010) $1 million: Plaintiff, 48-year old small business owner, was sideswiped on the highway causing his car to roll over numerous times. Plaintiff ended up with fractured ribs, a fractured shoulder and diffuse axonal brain damage leaving him with permanent memory loss, total loss of smell and taste and other cognitive problems.

  • Weimer v Classen (Washington 2008) $500,000: Plaintiff, a 29-year old construction worker, was riding his motorcycle when a left-turning transport van struck him. He suffered a diffuse axonal brain injury and was in a coma for over a month before he eventually died. The case settled for policy limits of $500,000.

  • Dahl v Joussett (New Jersey 2007) $595,000: Plaintiff, a 19-year-old student, was stopped at a red light when she was rear ended by a drunk driver. She suffered diffuse axonal brain damage which left her with speech difficulties and balance problems. She also had back injuries and a fractured hip.

Contact Miller & Zois About Diffuse Axonal Brain Injuries

If you or a family member suffered a diffuse axonal brain injury (or another type of brain injury) in an accident that was caused by someone else's negligence, contact Miller & Zois. Cases involving brain injuries are more complicated than other types of personal injury cases. You need lawyers who are experienced and understand the science of brain injuries. The brain injury attorneys at Miller & Zois can help you investigate your case and find out if you may be entitled to compensation. If you have a brain injury case and want an experienced firm who can take the case to trial, call 800-553-8082 or get a free online consultation here.

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