Clinicoradiological Study of Diffuse Axonal Injury: A Longitudinal Study

Introduction: Damage to the axons in neural brain tracts, corpus callosum, and brainstem, known as Diffuse Axonal Injury (DAI), can result in considerable morbidity and mortality in patients with head injuries. This type of injury involves microscopic damage and can have severe consequences.

Aim: To investigate the incidence, clinical features, and radiological findings of DAI on Magnetic Resonance Imaging (MRI) and to associate MRI grading with neurological outcome using the Glasgow Outcome Scale (GOS).

Materials and Methods: A longitudinal study was conducted in the Department of Neurosurgery, Jayarogya group of Hospitals, Gajra Raja Medical College, Gwalior,Madhya Pradesh, India, from December 2017 to November 2019. All the patients with Glasgow coma scores of eight or less with Computed Tomography (CT) and MRI brain findings consistent with DAI were included. The study collected data on patients including sociodemographic information, clinical variables related to trauma, details of hospital admission and stay, and variables related to the severity and consequences of DAI. Glasgow Coma Scale (GCS) was noted after resuscitation, MRI brain was done in stable patients. The neurological outcome was assessed after six months using the GOS and associated with MRI brain grading. The analyses were done using Statistical Package for Social Sciences (SPSS) version 26.0 and the frequencies were reported as percentages.

Results: Total patients with head injury were N=694 and out of which patients with DAI n=94. The mean age was 33.97 years with a male:female ratio of 4.33:1. Grade 1, grade 2, and grade 3 MRI brain findings were present in 50% (N=50), 31.25% (N=20), and 18.75% (N=12) of cases. Most common site for contusions was parietal-temporo-occipital region found in 85.93% cases. Regarding functional outcome, poor outcome was observed in 26.67% (n=4) of grade II DAI and 75% (n=9) of patients of grade III DAI.

Conclusion: DAI is major mechanism involved in Traumatic Brain Injury (TBI). In affected patients, long term hospitalisation is necessary. Patients with MRI grade I and II had a good outcome.