Journal ofNeurology, Neurosurgery, and Psychiatry 1989;52:838-841 Diffuse axonal injury in head trauma

SUMMARY Diffuse axonal injury (DAI) as defined by detailed microscopic examination was found in 34 of 80 consecutive cases of head trauma surviving for a sufficient length of time to be clinically assessed by the Royal Adelaide Hospital Neurosurgery Unit. The findings indicate that there is a spectrum ofaxonal injury and that one third ofcases ofDAI recovered sufficiently to talk between the initial head injury producing coma and subsequent death. The macroscopic "marker " lesions in the corpus callosum and dorsolateral quadrants of the brainstem were present in only 15/34 of the cases and represented the most severe end of the spectrum of DAI. Diffuse axonal injury (DAI) that is, widespread damage to axons in the white matter of the brain, was originally defined by Strich ' and the concept was expanded by Adams et al.2 Strich described diffuse degeneration of the cerebral white matter in a series of patients with severe post traumatic dementia and in a subsequent paper concluded that the axonal damage was produced by mechanical forces shearing the fibre