No products in the cart.

No products in the cart.

Diffuse Axonal Injury: Symptoms, Recovery, and Treatment

doctor explaining what a diffuse axonal injury is

Generally, diffuse axonal injuries (DAI) are a severe type of traumatic brain injury that affects multiple areas of the brain. As a result, various connections within the brain may become disrupted, leading to a wide range of secondary effects. Fortunately, many individuals with diffuse axonal injuries have the potential to recover affected functions and improve their quality of life.

To help you understand what to expect after a diffuse axonal injury, this article will discuss its:

Causes of Diffuse Axonal Injury

A diffuse axonal injury occurs when the brain quickly moves inside the skull as a result of a traumatic injury, such as a car accident. As the force of the impact causes the brain to repeatedly hit against the inside of the skull, the long connecting fibers in the brain, known as axons, can tear and potentially cause severe damage.

Doctors call this type of injury axonal shearing. The tearing of the axons disrupts the transmission of messages between neurons, leading to a loss of function. Additionally, axonal shearing causes swelling in the brain, which increases pressure in the skull.

Because most diffuse axonal injuries result in microscopic tears, damage can be difficult to detect with imaging.

Any strong shaking, sudden acceleration, or blunt injury can lead to axonal shearing. Some of the most common causes of diffuse axonal injury include:

Diffuse axonal injuries are one of the common types of injuries to occur following severe trauma to the head. In fact, they are present in over 40% of hospital admissions related to traumatic brain injury.

Generally, the more severe the traumatic event, the higher the potential for axonal shearing to occur. Diffuse axonal injuries most commonly affect the cerebral cortex, corpus callosum, and brain stem.

To help you understand what to expect when a DAI occurs, the following section will discuss common secondary effects of diffuse axonal injury.

Diffuse Axonal Injury Symptoms

A diffuse axonal injury causes axonal shearing at multiple regions of the brain. Because of this, individuals may experience a wide range of secondary effects at varying severities.

The primary symptom of diffuse axonal injury is loss of consciousness. Mild forms of DAI are often characterized by a coma without a focal lesion and axonal damage at various regions of the brain.

However, not everyone with a DAI will lose consciousness. Other symptoms of this type of injury include:

  • Cognitive deficits such as difficulty with memory, problem solving, and decision making. Loss of memory is one of the most common problems after DAI.
  • Confusion may occur as a result of cognitive deficits.
  • Severe headaches may occur as a result of inflammation of the brain.
  • Nausea and vomiting may occur due to balance problems caused by cerebellum damage or as a result of severe headaches.
  • Communication difficulties may occur if the areas of the brain responsible for motor control or the language centers of the brain are affected.
  • Motor impairments may occur if the regions of the brain responsible for regulating movement such as the motor cortex, brainstem, thalamus, or cerebellum are affected. As a result, individuals may experience weakness or paralysis, loss of balance, and/or abnormal muscle tone.
  • Behavioral changes such as irritability, dependency, anxiety, depression, and mood swings.
  • Dysautonomia refers to a malfunction of the autonomic nervous system which controls unconscious bodily functions such as heart rate, digestion, and breathing. Individuals with dysautonomia may experience fatigue, low blood pressure, dizziness, and anxiety attacks.

Depending on which areas of the brain are affected and the severity of axonal shearing, individuals may experience several of these secondary effects.  Up next, we’ll discuss the various classifications of DAIs.

Diffuse Axonal Injury Grading System

Diffuse axonal injuries disrupt the connections between neurons. As a result, various functions of the brain can be affected. Generally, the more severe the diffuse axonal injury, the longer the duration of coma.

The Adams classification of diffuse axonal injury is often used to describe the severity of a diffuse axonal injury. It includes 3 categories:  

  • Grade 1 (mild DAI) ischaracterized by axonal damage in the white matter of the cerebral cortex.
  • Grade 2 (moderate DAI) is characterized by a focal lesion in the corpus callosum in addition to axonal damage in the white matter of the cerebral hemisphere.
  • Grade 3 (severe DAI) is characterized by focal lesions in the corpus callosum and brainstem, as well as axonal damage in the white matter of the cerebral hemisphere.

Fortunately, even after a severe diffuse axonal injury, there is hope for recovery.

Diffuse Axonal Injury Recovery Signs

doctor checking for eye reflex in patient with diffuse axonal injury

Many patients who recover from a diffuse axonal injury demonstrate similar signs. These signs are typically a positive indication of working brain function.

The presence of neurological reflexes is typically viewed as a positive sign of diffuse axonal injury recovery. Following a DAI, physicians may look for:

  • Pupillary reactivity. This reflex involves shining a light on the patient’s eyes. If their pupils shrink, it indicates that the brain stem is functioning.
  • Oculocephalic response. These reflex tests that when the individual’s head is turns to the left, their eyes turn to the right. This is also a test for the brain stem.
  • Gag reflex. This reflex tests that the individual gags or coughs when a cotton swab or medical tube makes contact with the throat.

To further enhance recovery outcomes, various treatment interventions may be recommended. In the following section, we’ll address rehabilitative treatments that can help individuals with DAIs improve their functional abilities.

Diffuse Axonal Injury Treatment

Diffuse axonal injuries are often more challenging to treat than focal brain injuries because they affect multiple areas of the brain.

The severity of a DAI has a major impact on one’s recovery outlook. For example, those who regain consciousness within two weeks are considered to have a milder injury and are more likely to achieve full recovery. In cases of more severe DAIs, recovery is more difficult to predict. However, regardless of the severity of the injury, individuals may be able to recover affected functions by utilizing neuroplasticity.

Neuroplasticity refers to the brain’s ability to reorganize its neural circuitry based on the behaviors we repetitively perform. It allows for functions affected by brain damage to be rewired to unaffected regions of the brain. Furthermore, these functions can be improved through intensive practice.

During the first few months after a diffuse axonal injury, the brain experiences a heightened state of neuroplasticity. As a result, individuals are often able to promote adaptive changes at a quicker rate. One way to take advantage of this is to participate in rehabilitative therapy as soon as possible. Below, we’ll discuss several interventions that can help promote DAI recovery.

Physical Therapy

One of the main goals of physical therapy during diffuse axonal injury recovery is to regain control over your movements.

After a DAI, the connection between the brain, nerves, and muscles is disrupted. By participating in physical therapy, individuals can learn effective exercises that target the affected body parts and stimulate the brain to utilize neuroplasticity.

Want 25 pages of TBI recovery exercises in PDF form? Click here to download our free TBI Rehab Exercise ebook now (link opens a pop up for uninterrupted reading)

Speech Therapy

If your diffuse axonal injury has affected your ability to speak or swallow, speech therapy is essential. A speech-language pathologist will guide you through various activities and exercises to strengthen your orofacial muscles, improve your social communication skills, and address cognitive deficits.

Occupational Therapy

Occupational therapy (OT) works on developing the specific skills you need to regain independence in your home, work environment, or community. It often involves practicing activities of daily living such as feeding, transferring, and dressing to improve your functional abilities.

If mobility is significantly affected by DAI, occupational therapy may involve learning new ways to perform everyday activities such as using adaptive tools. This will help compensate for loss of motor control and allow individuals to perform tasks they otherwise may not be able to.

Cognitive-Behavioral Therapy

Some individuals may struggle to adapt to life after axonal brain injury. Cognitive-behavioral therapy helps individuals understand what is causing their negative thoughts or behaviors and teaches them more effective ways to cope.

Diffuse Axonal Injury: Key Points

Diffuse axonal injury is a serious condition and can be one of the most debilitating types of traumatic brain injuries. But as with all brain injuries, the key to making a good recovery lies in activating neuroplasticity through therapeutic exercises.

By participating in rehabilitative therapies, individuals have the potential to recover affected functions and significantly improve their quality of life.

Keep it going: Do you know these 15 essential TBI recovery tips?

If you like our content, you’ll love our ebook and newsletters! Get instant access to our TBI recovery tips ebook with 20 pages of helpful advice by signing up below.

You’ll also receive our emails that share survivor stories and more useful TBI recovery tips, which you can opt out of at any time. (We know you’ll love them, too.)

We will never sell your email address, and we never spam. That we promise.

More Ways to Recover with Flint Rehab:

Download Free TBI Recovery Tips!

15 Things Every TBI Survivor Must Know

Discover Award-Winning Neurorehab Tools

You're on a Roll: Read More Popular Articles on TBI Recovery

Do you want to sharpen your cognitive skills after a TBI?

Time with a speech therapist is extremely valuable during recovery, especially if you struggle with communication, critical thinking, or memory after brain injury. Insurance typically covers speech therapy for a fixed amount of time. But once it’s over, recovery is in your hands.

That’s why a team of neuroscientists and clinicians from Boston University created the CT Speech & Cognitive Therapy app. Designed for those recovering from stroke, TBI, or living with neurological conditions, the app contains over 100,000 cognitive exercises that are all available right from your phone or tablet. That’s like having a speech therapist by your side whenever you want!

This app is the perfect fit if you want to improve your speaking, memory, or general mental sharpness. And, it’s affordable at just $29.99/month!

Click here to learn more about the CT app

See what Miriam said about the CT Speech & Cognitive Therapy app:

“For the past 6 months, my son has used the app about three times a week. The app is like a virtual therapist, it’s very easy to use, and it gives him immediate feedback.

He now understands things faster, can make decisions with less hesitation, has improved recognition of words, and his confidence is higher. I also find it easy to get in touch with customer service; they pleasantly help out. The whole experience has been great.”

— Miriam

It’s like having a virtual speech therapist available anytime you want

With the CT App, you can get the guidance you need right from your phone or tablet. You can use it on your own or in between sessions with your speech therapist.

Whether you struggle with aphasia, memory loss, or critical thinking, the CT Speech & Cognitive Therapy App can help.

“The CT app has helped me gather my confidence by building on and reinforcing old forgotten skills. It helps to see my percentages increase, and work harder when they decrease. It’s very self-motivating.” -Kathryn

We are confident that this app will help improve your speech and cognitive function after brain injury. Like our recovery tools, the CT App is also covered by our 30-day money-back guarantee.

15 Things Every TBI Survivor Must Know

Do you know these 15 TBI recovery tips?

Get a free copy of our ebook 15 Things Every TBI Survivor Must Know. Click here to get instant access.