Diffuse Axonal Injury

Neurotrauma ◽  
2019 ◽  
pp. 63-72
Author(s):  
Hussein A. Zeineddine ◽  
Cole T. Lewis ◽  
Ryan S. Kitagawa
Keyword(s):  
Cerebral Perfusion ◽  
High Speed ◽  
Motor Vehicle ◽  
Axonal Injury ◽  
Diffuse Axonal Injury ◽  
Common Mechanism ◽  
White Matter Tract ◽  
Vehicle Accidents ◽  
Wide Range ◽  
Tract Damage

Diffuse axonal injury (DAI) is a type of traumatic brain injury (TBI) that results from a blunt head injury. In this particular subtype, accelerating-decelerating motions cause white matter tract damage and preferentially impact regions including the corpus callosum and brainstem. The neurological compromise therefore relates to the severity of the axonal insult. The most common mechanism for DAI is high-speed motor vehicle accidents, and the clinical presentation is typically out of proportion to the CT findings. As a result, MRI is the modality of choice. Currently, there are limited therapeutic options, and management is identical to other forms of TBI including intracranial pressure and cerebral perfusion pressure management. As this disease is heterogeneous, survivors have a wide range of functional outcomes.

Simulating Axonal Stretch During Traumatic Brain Injury Events

2010 ◽  
Author(s):  
Jean-Pierre Dollé ◽  
Jeffrey Barminko ◽  
Rene Schloss ◽  
Martin L. Yarmush
Keyword(s):  
Brain Injuries ◽  
Motor Vehicle ◽  
Axonal Injury ◽  
Diffuse Axonal Injury ◽  
The United States ◽  
Motor Vehicle Accidents ◽  
Inertial Forces ◽  
Vehicle Accidents ◽  
Rapid Deceleration ◽  
The Brain

Traumatic Brain Injuries (TBI) affect up to 1.5 million people annually within the United States with as many as 250,000 being hospitalized and 50,000 dying [1]. TBI events occur when the brain experiences a sudden trauma such as a rapid deceleration of the brain that typically occurs during motor vehicle accidents. During rapid deceleration events, the brain is subjected to high inertial forces that can result in a shearing or elongation of axons that is commonly known as Diffuse Axonal Injury (DAI) [2,3].

scholarly journals Brainstem Diffuse Axonal Injury and Consciousness

2019 ◽  
Vol 9 ◽  
pp. 32 ◽  
Author(s):  
Sukhwinder Sandhu ◽  
Erik Soule ◽  
Peter Fiester ◽  
Patrick Natter ◽  
Daryoush Tavanaiepour ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Brain Injuries ◽  
Motor Vehicle ◽  
Axonal Injury ◽  
Diffuse Axonal Injury ◽  
Prognostic Indicator ◽  
Coma Scale ◽  
Vehicle Accidents ◽  
Neurological Outcomes ◽  
Neurological Injuries

Background: Severe traumatic brain injuries (TBI), commonly due to motor vehicle accidents may cause death and long-term disability especially when the acceleration-deceleration force on the brain is massive. This may cause shearing of the axonal connections within the cerebral cortex and brainstem in a process referred to as diffuse axonal injury (DAI). Extensive DAI has been postulated to be a poor prognostic indicator for neurological recovery. In our institution, several patients with Grade 3 DAI were observed to recover and achieve neurological outcomes greater than expected given the presence of brainstem injury. Methods: MRI studies from 100 patients admitted to a large tertiary trauma center for TBI were retrospectively analyzed by two fellowship-trained neuroradiologists. The size of DAI lesions, location of injury within the brainstem, and the number of discrete DAI lesions were measured and recorded. Glasgow Coma Scale (GCS) on arrival and at discharge was noted, as well as the presence of other neurological injuries. Results: Of 20 patients initially noted to have DAI with lesions of the brainstem, eight of them were discharged with Glasgow Coma Scale (GCS) of 14–15. The 12 patients discharged with reduced consciousness (average GC 7.1) demonstrated a greater number of larger lesions, with a predilection for the dorsal pons. Conclusion: These results suggest that large, numerous pontine lesions may indicate worse neurological outcomes in patients with these findings.

Airbag Inflators

1999 ◽  
Author(s):  
William G. Broadhead ◽  
D. Theodore Zinke
Keyword(s):  
High Speed ◽  
Motor Vehicle ◽  
Seat Belt ◽  
Design Parameters ◽  
Steering Wheel ◽  
Instrument Panel ◽  
Highway Traffic ◽  
National Highway Traffic Safety ◽  
Column Collapse ◽  
Wide Range

Abstract The design of an airbag restraint system presents a classic engineering challenge. There are numerous design parameters that need to be optimized to cover the wide range of occupant sizes, occupant positions and vehicle collision modes. Some of the major parameters that affect airbag performance include, the airbag inflator characteristics, airbag size and shape, airbag vent size, steering column collapse characteristics, airbag cover characteristics, airbag fold pattern, knee bolsters, seat, seat belt characteristics, and vehicle crush characteristics. Optimization of these parameters can involve extremely costly programs of sled tests and full scale vehicle crash tests. Federal Motor Vehicle Safety Standards (FMVSS) with regard to airbag design are not specific and allow flexibility in component characteristics. One design strategy, which is simplistic and inexpensive, is to utilize a very fast, high output gas generator (inflator). This ensures that the bag will begin restraining the occupant soon after deployment and can make up for deficiencies in other components such as inadequate steering column collapse or an unusually stiff vehicle crush characteristic. The use of such inflators generally works well for properly positioned occupants in moderate to high-speed frontal collisions by taking advantage of the principle of ridedown. When an airbag quickly fills the gap between the occupant and the instrument panel or steering wheel it links him to the vehicle such that he utilizes the vehicle’s front-end crush to help dissipate his energy, thus reducing the restraint forces. Unfortunately, powerful airbag systems can be injurious to anyone in the path of the deploying airbag. This hazard is present for short statured individuals, out of position children or any occupant in a collision that results in extra ordinary crash sensing time. Currently, the National Highway Traffic Safety Administration (NHTSA) is proposing to rewrite FMVSS 208 to help reduce such hazards.

Circumferential fracture of the skull base causing craniocervical dislocation

2002 ◽  
Vol 97 (1) ◽  
pp. 118-122 ◽  
Author(s):  
Ganesh Rao ◽  
Adam S. Arthur ◽  
Ronald I. Apfelbaum
Keyword(s):  
High Speed ◽  
Unusual Case ◽  
Motor Vehicle ◽  
Neurological Impairment ◽  
Craniocervical Junction ◽  
Motor Vehicle Accidents ◽  
Review Of The Literature ◽  
Content Type ◽  
Vehicle Accidents ◽  
Fine Print

✓ Fractures of the craniocervical junction are common in victims of high-speed motor vehicle accidents; indeed, injury to this area is often fatal. The authors present the unusual case of a young woman who sustained a circumferential fracture of the craniocervical junction. Despite significant trauma to this area, she suffered remarkably minor neurological impairment and made an excellent recovery. Her injuries, treatment, and outcome, as well as a review of the literature with regard to injuries at the craniocervical junction, are discussed.

scholarly journals Intra-Testicular Papaverine Injection for Testicular Salvage after Blunt Testicular Trauma: A Case Report

2019 ◽  
Vol 13 (2) ◽  
pp. 110-112
Author(s):  
Kevin Keating ◽  
Paulette C. Dreher ◽  
Jason Levy ◽  
Brian McGreen ◽  
Daniel Edwards ◽  
...  
Keyword(s):  
High Speed ◽  
Motor Vehicle ◽  
Primary Repair ◽  
Tunica Albuginea ◽  
Current Evidence ◽  
Common Mechanism ◽  
Surgical Interventions ◽  
Surgical Exploration ◽  
Valuable Treatment ◽  
Testicular Trauma

Blunt trauma is the most common mechanism of injury to the scrotum and testicle. Surgical exploration with primary repair, hematoma evacuation, and de-torsion are common surgical interventions. A 20-year-old male with no previous medical history presented after a high-speed motor vehicle collision. Ultrasonography demonstrated heterogeneous changes of the tunica albuginea and decreased arterial flow to bilateral testicles. He was subsequently taken to the operating room for surgical exploration, which revealed bilateral mottled testes with questionable viability. Papaverine was injected into each testicle, which resulted in visibly increased perfusion and subsequent preservation of the testicles. Conclusion: Current evidence on the use of papaverine is isolated to testicular torsion. Additional research should be conducted on the use of papaverine in blunt testicular trauma. Papaverine injection may be a valuable treatment option when inadequate perfusion is observed intra-operatively.

scholarly journals Hepatothorax: A Rare Outcome of High-Speed Trauma

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Matthew Porcelli ◽  
Oksana Prychyna ◽  
Andrew Rosenthal ◽  
Joseph DeCostanza
Keyword(s):  
Early Diagnosis ◽  
High Speed ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Motor Vehicle Crashes ◽  
Diagnosis And Treatment ◽  
Diagnostic Tools ◽  
Common Mechanism ◽  
Trauma Unit ◽  
Level I

Diaphragmatic ruptures are the result of severe blunt trauma or penetrating trauma. Motor vehicle crashes are a common mechanism associated with blunt diaphragmatic rupture (BDR). Incorporating diagnostic tools and laparotomy assist in the diagnosis and treatment of BDR. However, diagnosing BDR can be a challenge for practitioners. Early diagnosis and treatment improve the patient's outcomes. This paper details the events of a patient received in a level I trauma unit.

Effects of Muscle Tone on Diffuse Axonal Injury in Vehicle Accidents

2018 ◽  
Vol 2018.29 (0) ◽  
pp. 2B21
Author(s):  
Ryoichi UCHIDA ◽  
Yuki DEZAKI ◽  
Toshiaki SAKURAI ◽  
Tetsuo MAKI
Keyword(s):  
Muscle Tone ◽  
Axonal Injury ◽  
Diffuse Axonal Injury ◽  
Vehicle Accidents

scholarly journals Renal trauma: the current best practice

2018 ◽  
Vol 10 (10) ◽  
pp. 295-303 ◽  
Author(s):  
Tomer Erlich ◽  
Noam D. Kitrey
Keyword(s):  
Renal Injury ◽  
Best Practice ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
High Energy ◽  
Renal Trauma ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Vehicle Accidents ◽  
Enhanced Computed Tomography

The kidneys are the most vulnerable genitourinary organ in trauma, as they are involved in up to 3.25% of trauma patients. The most common mechanism for renal injury is blunt trauma (predominantly by motor vehicle accidents and falls), while penetrating trauma (mainly caused by firearms and stab wound) comprise the rest. High-velocity weapons impose specifically problematic damage because of the high energy and collateral effect. The mainstay of renal trauma diagnosis is based on contrast-enhanced computed tomography (CT), which is indicated in all stable patients with gross hematuria and in patients presenting with microscopic hematuria and hypotension. Additionally, CT should be performed when the mechanism of injury or physical examination findings are suggestive of renal injury (e.g. rapid deceleration, rib fractures, flank ecchymosis, and every penetrating injury of the abdomen, flank or lower chest). Renal trauma management has evolved during the last decades, with a distinct evolution toward a nonoperative approach. The lion’s share of renal trauma patients are managed nonoperatively with careful monitoring, reimaging when there is any deterioration, and the use of minimally invasive procedures. These procedures include angioembolization in cases of active bleeding and endourological stenting in cases of urine extravasation.

A Numerical Analysis of Pre-Deployment Effect of Side-Impact Airbags in Reducing Occupant Injuries

2013 ◽  
Author(s):  
Yi Yang Tay ◽  
Rasoul Moradi ◽  
Hamid M. Lankarani
Keyword(s):  
Numerical Analysis ◽  
High Speed ◽  
Motor Vehicle ◽  
Side Impact ◽  
Element Analysis ◽  
Vehicle Accidents ◽  
Injury Criteria ◽  
Acceleration Sensors ◽  
Head Injury Criteria ◽  
Occupant Injuries

Side impact collisions represent the second greatest cause of fatality in motor vehicle accidents. Side-impact airbags (SABs), though not mandated by NHTSA, have been installed in recent model year vehicle due to its effectiveness in reducing passengers’ injuries and fatality rates. However, the increase in number of frontal and side airbags installed in modern vehicles has concomitantly led to the rise of airbag related injuries. A typical side-impact mechanical or electronic sensor require much higher sensitivity due to the limited crush zones making SABs deployment more lethal to out-of-position passengers and children. Appropriate pre-crash sensing needs to be utilized in order to properly restraint passengers and reduce passengers’ injuries in a vehicle collision. A typical passenger vehicle utilizes sensors to activate airbag deployment when certain crush displacement, velocity and or acceleration threshold are met. In this study, it is assumed that an ideal pre-crash sensing system such as a combination of proximity and velocity and acceleration sensors is used to govern the SAB pre-deployment algorithm. The main focus of this paper is to provide a numerical analysis of the benefit of pre-deploying SAB in lateral crashes in reducing occupant injuries. The effectiveness of SABs at low and high speed side-impact collisions are examined using numerical Anthropomorphic Test Dummy (ATD) model. Finite Element Analysis (FEA) is primarily used to evaluate this concept. Velocities ranging from 33.5mph to 50mph are used in the FEA simulations. The ATD used in this test is the ES-2re 50th percentile side-impact dummy (SID). Crucial injury criteria such as Head Injury Criteria (HIC), Thoracic Trauma Index (TTI), and thorax deflection are computed for the ATD and compared against those from a typical airbag system without pre-crash sensing. It is shown that the pre-deployment of SABs has the potential of reducing airbag parameters such as deployment velocity and rise rate that will directly contribute to reducing airbag related injuries.

scholarly journals Treatment Options for Brachial Plexus Injuries

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Vasileios I. Sakellariou ◽  
Nikolaos K. Badilas ◽  
Nikolaos A. Stavropoulos ◽  
George Mazis ◽  
Helias K. Kotoulas ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
High Speed ◽  
Review Paper ◽  
Motor Vehicle ◽  
Treatment Options ◽  
Motor Vehicle Accidents ◽  
Future Prospects ◽  
Current Management ◽  
Vehicle Accidents ◽  
Conservative And Operative Treatment

The incidence of brachial plexus injuries is rapidly growing due to the increasing number of high-speed motor-vehicle accidents. These are devastating injuries leading to significant functional impairment of the patients. The purpose of this review paper is to present the available options for conservative and operative treatment and discuss the correct timing of intervention. Reported outcomes of current management and future prospects are also analysed.

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