A diffuse axonal brain injury (DAI) is a specific type of traumatic brain injury that can have devastating consequences for victims and their families. Often caused by sudden, forceful motions, DAIs occur when the brain’s nerve fibers are damaged after a traumatic incident, such as a car crash, fall, or assault. Diffuse axonal injuries are one of the most severe forms of brain damage, leading to long-term cognitive and physical impairments.
Handling the aftermath of a diffuse axonal brain injury poses a life-altering challenge. When these injuries result from someone’s negligence, seeking legal counsel with a qualified brain injury lawyer is essential. Brain injuries are vastly complicated from both a medical and legal point of view and should not be handled without expert guidance. In this article, we discuss the implications of diffuse axonal brain injuries, their prognosis and diagnosis, and how hiring a lawyer can help families recover from these devastating injuries.
What is a Diffuse Axonal Brain Injury?
Diffuse axonal brain injuries occur when the connective nerve fibers in the brain (axons) are torn. After a traumatic impact or jolt to the head, rapid acceleration and deceleration cause the brain to move and bounce around inside the skull. This sudden, violent motion can stretch and shear the axons, causing severe brain damage that impacts cognition, sensory perception, and motor skills.
Think of the brain as a complex communication network, where axons are like wires that allow individuals to send and receive messages. In a diffuse axonal injury, these “wires” are not merely disconnected in one place; the damage is scattered throughout the entire network, disrupting the brain’s ability to communicate with itself and function as a cohesive whole.
This is one of the most critical types of traumatic brain injury (TBI), with mortality rates as high as 30.8%. The damage is not localized but is “diffused” throughout the brain, complicating treatment and recovery. Most patients will present in a coma or vegetative state, with a high risk of long-term disability, or death.
Given the severity of these injuries, immediate and comprehensive medical care is crucial. Understanding the nature of DAIs is the first step in the recovery process and deciding to seek compensation for damages.
What is brain shearing?
The term “brain shearing” or “shearing injury” is often associated with diffuse axonal injuries, and refers to the stretching and tearing of nerve fibers, damaging the brain’s white matter. You might hear doctors or lawyers use this term when describing your or your loved one’s condition. “Shearing” describes the mechanism of injury: as different parts of the brain move at varying speeds or directions, the tissues slide against each other, deforming brain matter and causing damage to the axons.
Brain shearing is particularly worrisome because it often results in microscopic lesions across multiple regions of the brain, making it difficult to detect with standard imaging techniques. This usually results in loss of consciousness, but in certain mild cases, someone who has experienced brain shearing may appear mostly normal until symptoms become evident.
What is the prognosis after a diffuse axonal injury?
The prognosis for a diffuse axonal injury depends on the severity of the injury and the extent of axonal damage, but it is often poor, with outcomes ranging from mild impairments to permanent disability or death. Some individuals with milder forms of DAI may see near-complete recovery, but severe cases will result in long-term challenges and require ongoing care. Factors like the patient’s health, age, the location of brain lesions, and the quality of care available also play a role in determining outcomes.
Diffuse axonal injuries are complex because they involve varying grades of widespread brain damage (rather than isolated damage, as with a focal brain injury), which makes predicting recovery difficult. Early medical intervention, comprehensive rehabilitation, and careful diagnostic testing can improve recovery potential and should be prioritized. Even in cases that may seem mild, all DAIs should be taken seriously. Understanding the prognosis can help set realistic expectations and plan for the future.
Each instance of DAI is unique, affecting different parts of the brain and manifesting a wide range of symptoms. The grade of the injury and the immediate symptoms will influence a patient’s long-term outlook, so it is important to know what to look for. Below, we outline the common symptoms of the injury and explain the three grades of severity.
Symptoms of diffuse axonal injuries
After a diffuse axonal injury, the victim’s symptoms will reflect the amount of brain damage sustained and can foreshadow the path that lies ahead. Common symptoms include:
- Loss of consciousness (ranging from minutes to multiple days)
- Confusion
- Memory loss
- Nausea and vomiting
- Dizziness and impaired coordination
- Mood swings, irritability, or depression (immediate or prolonged)
- Difficulty seeing and hearing
- Deep Coma
The combination and severity of these symptoms will vary depending on the grade of the injury. They are key indicators that help medical professionals diagnose DAI and determine a prognosis. Overall, loss of consciousness is the hallmark sign of DAI. This further complicates diagnostics as patients may be unable to communicate with doctors and therefore won’t exhibit additional manifestations of the injury.
Grades of Diffuse Axonal Injuries
Diffuse axonal brain injuries are classified into three grades, based on the extent of brain damage:
- Grade 1 (Mild): Damage is limited to microscopic tearing in the cerebral cortex, corpus callosum, brainstem, and sometimes the cerebellum. Patients usually experience a headache, dizziness, and other concussion-like symptoms. Many patients recover with proper treatment. Mild DAIs are difficult to detect, making diligent medical care extremely important.
- Grade 2 (Moderate): Larger, more visible brain lesions on the corpus callosum (a thick nerve tract in the center of the brain) are detectable by an MRI. Patients may lose consciousness for a prolonged period, experience cognitive impairments, and have trouble posturing themselves normally. Recovery is possible but often incomplete, with patients requiring extended rehabilitation and some deficits persisting.
- Grade 3 (Severe): A combination of widespread axonal tearing and features of grade 2, in addition to lesions and hemorrhages in the brainstem. Patients with severe DAI will experience prolonged coma and a high potential for persistent vegetative state and death. Survivors face profound challenges, including loss of independence, difficulty communicating, and other severe physical and cognitive impairments.
Understanding the symptoms and severity of a diffuse axonal injury is crucial in determining treatment options, long-term prognosis, and legal recourse when the injury is caused by negligence.
Misdiagnosis of DAI
Did you know that doctors often fail to diagnose brain injuries? A published by the Journal of Rehabilitation Medicine found that, out of 92 patients sampled in a recovery program, 85.5% of them had an undiagnosed traumatic brain injury (TBI). A more recent study from 2023 also highlights these issues, concluding that about 30.6% of patients who visit the ER after a motor vehicle accident do not receive acute care, and are later found to have a missed mild TBI diagnosis. These patients go on to develop additional symptoms.
Mild diffuse axonal injuries are sometimes misdiagnosed as concussions. Misdiagnosis is one of the leading causes of medical malpractice, and can massively reduce the chances of recovery. Most diagnoses of diffuse axonal injuries are made after a patient has been in a coma for 6 hours, but victims of the injury do not always experience this.
The standard of care for head-injured patients is to implement an advanced trauma life support protocol. This involves airway management, circulatory support, assessing consciousness levels, and rapid image testing (CT scans or MRIs). When a victim of a diffuse axonal brain injury does not receive this standard of care, the consequences can be detrimental, and a medical malpractice claim should be filed.
How is a diffuse axonal brain injury diagnosed?
Doctors and nurses diagnose DAI based on the patient’s presentation and neuroimaging results, and there are no lab tests for the injury. DAI is most often suspected in ER patients who have experienced trauma from high-impact rotational movement, and rapid acceleration-deceleration, and who have lost consciousness. Witnesses are important, as knowing the specific cause of the injury–such as a car accident, fall, or a violent assault–helps doctors determine a precise diagnosis.
With current medical technology, a definitive diagnosis of DAI can only be made by examining brain tissue after death. Because DAI involves widespread, microscopic damage (sometimes without larger lesions), standard imaging techniques can fall short, and medical teams must rely on their best judgment. Doctors will use the following diagnostic tools:
- Computed Tomography (CT) Scans:CT scans are the first tool doctors use to examine patients with head injuries, but they rarely detect DAIs. Although a CT scan may detect hemorrhages and focal damage, they are unreliable in picking up small axonal tears across the brain. Additional tests should always follow to avoid a missed diagnosis.
- Magnetic Resonance Imaging (MRI): MRI is currently the preferred imaging method for diagnosing DAI, with a sequence called “diffusion tensor imaging” (DTI) offering the best visualization of axonal damage. Another MRI sequence called “gradient-recalled echo” (GRE) may further improve the detection of Grade 3 DAIs, making it a valuable tool in assessing severe cases. Medical teams should perform both DTI and GRE tests before they diagnose a patient.
- Electroencephalogram (EEG): An EEG is a test that records electrical activity in the brain. It is used to diagnose brain disorders like seizures and epilepsy, and helps evaluate brain condition after a TBI or a stroke. Using an EEG may help doctors evaluate and diagnose a diffuse axonal injury, but it should never be used on its own.
Patients who have experienced head trauma and lost consciousness should always be thoroughly tested for diffuse axonal injuries. An accurate diagnosis is essential not only for proper treatment and recovery but also for legal claims relating to traumatic brain injuries (TBI). A proper diagnosis strengthens the foundation for pursuing necessary compensation for a brain injury. If medical negligence results in a misdiagnosis of DAI, a medical malpractice lawsuit is necessary for full compensation and recovery.
Compensation for Diffuse Axonal Brain Injuries
Diffuse axonal injuries are among the most devastating forms of traumatic brain injury, making appropriate compensation incredibly important. These injuries can rob individuals of their independence, career prospects, and overall quality of life.
If you or a loved one has been diagnosed with a diffuse axonal brain injury after a traumatic event, you may be entitled to compensation for a wide range of losses, including:
- Medical Expenses – Emergency care, hospital stays, surgery, prescription medications, and ongoing doctor visits.
- Rehabilitation Costs – Long-term care, including speech therapy, physical therapy, occupational therapy, and recreational therapy.
- Lost Wages and Future Earning Capacity – Many DAI victims are unable to return to work, requiring compensation for lost income and reduced earning potential.
- Pain and Suffering – Compensation for the physical pain, emotional distress, and mental anguish caused by the injury, for both victims and their family members.
- Loss of Quality of Life – Victims of DAIs often experience permanent disabilities, loss of independence, and an inability to engage in activities they once enjoyed.
- Home and Lifestyle Modifications – Costs associated with wheelchairs, home accessibility modifications, or in-home care services.
- Punitive Damages – In cases involving gross negligence or reckless misconduct—such as drunk driving or medical malpractice—punitive damages may be awarded to punish the at-fault party and deter similar behavior.
Given the severity of DAI, victims and their families often face overwhelming medical expenses and long-term care needs. When the injury is caused or worsened by another party’s negligence, pursuing legal action is critical to securing fair compensation for the damages incurred.
How a Brain Injury Lawyer Can Help
Diffuse axonal brain injury cases involve complex legal and medical issues, and these claims should not be fought alone. At Stalwart, we handle brain injury claims with the expertise and dedication you deserve. Our experienced brain injury lawyers offer personalized legal support to every client, meeting your needs with the care and precision that is necessary for a successful claim.
To help with your diffuse axonal injury claim, our attorneys wil:
- Gather medical records and expert testimony to prove the full extent of the injury
- Establish liability by demonstrating how negligence led to the DAI
- Calculate long-term financial and medical costs to ensure you receive the compensation you need
- Negotiate with insurance companies or litigate in court to fight for maximum damages
Because DAI cases frequently involve high-value claims, insurance companies may attempt to minimize payouts or deny responsibility. Working with a skilled brain injury attorney can make the difference between receiving a fair settlement and being left without adequate support.
For DAI victims and their families, securing proper compensation is about more than just financial recovery—it’s about accessing the best possible care, rehabilitation, and quality of life moving forward. By hiring a brain injury lawyer, you gain peace of mind and access to resources that can enhance your recovery and your claim’s success.
In summary, diffuse axonal brain injuries can have life-altering consequences, but understanding the nature of the injury, as well as how it might be mistreated, can empower victims and their families. You’ll find a strong ally in Stalwart’s brain injury attorneys, who will aid in your emotional, financial, and physical recovery. If you’re ready to take the next step in securing the compensation and support you deserve, contact our lawyers today.