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Traumatic Brain Injury Attorneys / Blackwell Law Firm

Diffuse Axonal Brain Injuries And Car Accidents

Traumatic Brain Injury Attorneys / Blackwell Law FirmLast week I wrote about Coup-Contrecoup brain injuries. You can read my post at Traumatic Brain Injury:  Coup and Contrecoup Brain Injuries Explained. We frequently see Coup-Contrecoup traumatic brain injuries in car accidents. Today, I’m writing about another TBI issue. This time the subject is Diffuse Axonal Injury (DAI). We sometimes see diffuse axonal injuries in very severe car accidents. We’ve also seen these injuries in some severe industrial and construction accident cases. So, what is a Diffuse Axonal Injury?

Normally, I write a few TBI articles every March. Why March? That month is designated as Brain Injury Awareness Month by public health groups. Throughout March, advocacy groups try and shed light on an important issue that is a leading cause of death and disability in the United States. We’ve seen many TBI issues, including the struggles of loved ones to help a suffering family member. So, March is a great time to talk about these important issues.

Why not wait until March to write these recent articles? Honestly, I read a blog post published by a ghostwriter for a local Alabama law firm that simply listed types of accidents and types of diagnoses. While the article’s title offered advice on TBIs and car accidents, the text offered little but keyword lists for search. I think articles should offer some real information or opinion. So, I decided to actually discuss the diagnoses listed by that firm. Let’s provide some real and helpful information!

What Is A Diffuse Axonal Brain Injury?

A brain injury can be either focal or diffuse. A focal injury is localized. Focal injuries are typically caused by a single blow to the head. A TBI that causes lesions in different areas of the brain is called “diffuse.” The damage is widespread.

What is a “diffuse axonal injury?” You may hear a doctor call this type of injury “axonal shearing.” These injuries involve the shearing or tearing of the brain’s long connecting nerve fibers (axons). Shearing can occur in different parts of the brain.

How do diffuse axonal injuries occur? Diffuse axonal injuries can occur in a number of different traumatic accidents from severe car crashes, to falls down stairs, to explosions. These TBIs occur when the brain moves rapidly inside the skull. Take a serious car accident as an example — The victim’s head can be thrust violently in multiple directions before the vehicles stop. The violent, rapid movements of the brain inside the skull can tear axons or disrupt brain signals.

In many cases, a diffuse axonal injury involves microscopic tears that are very difficult to detect with traditional imaging. That’s why many TBIs are not detected by CTs or MRIs. I’ve written about this lack of diagnostic testing in a couple prior blog articles. At our firm, we see many head injury cases where the initial CT at the emergency room is clear. Again, that’s because many brain injuries involve microscopic tears not easily detected by imaging. This creates a problem with treatment as many emergency rooms are focused entirely on what can be seen in images.

It also creates a later problem in personal injury cases where insurance companies try to cast doubt on the injury. In many of our “mild” brain injury cases, we work hard to make sure the client sees the right specialists for these injuries. And, we work hard to develop the testimony of witnesses with knowledge of the client’s everyday struggles. I put the word “mild” in quotes because it is a classification used within the medical community. In reality, many TBIs classified by medical standards as “mild” produce long-term impairments and disabilities. So, if you suspect your loved one suffers a TBI, consult with medical specialists who understand those issues! You need treatment from the right specialists as soon as possible.

What Are The Impacts Of A Diffuse Axonal Brain Injury?

Because a diffuse axonal injury causes shearing in multiple areas of the brain, victims can suffer a wide-range of problems. This makes them especially difficult to diagnose and treat.

The initial severity of a diffuse axonal injury can range from mild to very severe and even deadly. More severe diffuse axonal injuries often result in coma or death. Studies indicate a huge proportion of the TBIs that require hospitalization are diffuse axonal injuries. Here is how DAIs are graded by one scale:

The Adams Diffuse Axonal Injury Classification

  • Grade 1:  A mild diffuse axonal injury with microscopic white matter changes in the cerebral cortex, corpus collosum, and brainstem
  • Grade 2:  A moderate diffuse axonal injury with gross focal lesions in the corpus callosum
  • Grade 3:  A severe diffuse axonal injury with finding as Grade 2 and additional focal lesions in the brainstem

On the less severe end, diffuse axonal injuries result in microscopic changes that are difficult to detect on imaging. But, even these milder changes can result in long-term problems and disabilities. While a long period of unconsciousness or a coma are obvious symptoms in the more severe cases, the milder cases frequently produce symptoms which may include headaches, vomiting, fatigue, behavioral changes, sensory deficits, memory issues, trouble thinking, motor skills problems, dysautonomia (problems with autonomic nervous system function) and other issues throughout the body. We have seen many of these issues in our cases over the years — These widespread and diverse problems make these injuries difficult to treat.

What Are Some Causes Of Diffuse Axonal Brain Injuries?

According to some research from the National Institute of Health, the most common cause of diffuse axonal injury is a high-speed car accident. Researchers believe the accelerating and decelerating motions lead to shearing forces in the white matter of the brain. Here are some common traumas that can result in diffuse axonal injuries:

  • Automobile Accidents
  • Severe Falls (Especially ones causing whipping head motions)
  • Sports-Related Accidents
  • Child Abuse (Shaken Baby Syndrome)
  • Violent Attacks

As you can see, all these common DAI causes involve rapid or violent changes in head movement. Diffuse axonal injuries are serious brain injuries. They are one of the most debilitating types of head injury. While diffuse axonal injuries can present significant rehabilitative challenges, our brains are remarkable. We are very fortunate in both Huntsville and Birmingham to have specialists who understand these injuries and are able to help with the healing process.


The Blackwell Law Firm works exclusively with serious personal injury cases. From our office in Huntsville, we handle cases across Alabama. If you have questions about a personal injury, let us know. We are happy to provide answers. Our consultations are always free and confidential.