Challenges of Diffuse Axonal Injury Diagnosis

“This can't be right. Jay is in a vegetative state following a severe traumatic brain injury (TBI), but his computed tomography scan is essentially normal. How am I going to explain this to his mom?” This is a conversation I overhear among my rehabilitation nurse colleagues from time to time. Jay has a type of brain trauma called diffuse axonal injury (DAI). Recent statistics from the National Centers for Injury Prevention and Control ( NCIPC, 2006 ) indicate 1.4 million people sustain a TBI each year in the United States. The leading causes of TBI are falls (28%), motor vehicle accidents (20%), being struck by or against an object (19%), and assaults (11%; NCIPC). DAI, one of the most important causes of cognitive dysfunction after TBI ( Sugiyama et al., 2007 ), occurs in a more widespread pattern in certain regions of the brain than the localized zone of focal injuries. It is one of the most devastating forms of TBI and a common cause of vegetative state and severe disability. DAI occurs in 40%–50% of all patients who are hospitalized from TBI ( Meythaler, Peduzzi, Eleftheriou, & Novack, 2001 ).