A Delayed Presentation of Diffuse Axonal Injury

Diffuse axonal injury is one of the most common and debilitating pathologies resulting from mechanical deformation of the brain.  The current case involves a 19-year-old female involved in a high velocity ski crash. The accident resulted in a right lower leg fracture, with no loss of consciousness or evidence of head trauma.  Approximately 6.5 hours after her admission, the neurological status of the patient deteriorated markedly, and magnetic resonance imaging findings were consistent with diffuse axonal injury.  This presentation illustrates a case of delayed diffuse axonal injury, a phenomenon not commonly described.  Diffuse axonal injury involves rapid inertial forces causing strain to brain tissue.  This strain results in various stages of diffuse axonal damage and inflammation.  This article highlights a case of delayed onset diffuse axonal injury, describes the progression of neural sequelae post-injury resulting in axonal damage and explores proposed therapeutic targets.