Diffuse Axonal Injury Classification [Neurosurgery Wiki]

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====== Diffuse Axonal Injury Classification ======

The [[Diffuse Axonal Injury]] [[Classification]] was first proposed by Adams in [[1989]] 
((Adams JH, Doyle D, Ford I et-al. Diffuse axonal injury in head injury: definition, diagnosis and grading. Histopathology. 1989;15 (1): 49-59.))
and divides diffuse axonal injury (DAI) into three grades:

grade I : involves grey-white matter interfaces most commonly : parasagittal regions of frontal lobes, periventricular temporal lobes less commonly : parietal and occipital lobes, internal and external capsules, and cerebellum often inapparent on conventional imaging may have changes on MRS 3

grade II : involves corpus callosum in addition to stage I locations observed in approximately 20% of patients most commonly : posterior body and splenium but does advance anteriorly with increasing severity of injury most frequently unilateral may be seen on SWI 3
    
    
grade III : involves brainstem in addition to stage I and II locations most commonly : rostral midbrain, superior cerebellar peduncles, medial lemnisci and corticospinal tracts.

DTI with 3-D fiber tractography can visualize acute axonal shearing injury, which may have prognostic value for the cognitive and neurological sequelae of traumatic brain injury
((Le TH, Mukherjee P, Henry RG, Berman JI, Ware M, Manley GT. Diffusion tensor
imaging with three-dimensional fiber tractography of traumatic axonal shearing
injury: an imaging correlate for the posterior callosal "disconnection" syndrome:
case report. Neurosurgery. 2005;56(1):189. PubMed PMID: 15617604.
)).