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Diffuse Axonal Injuries and their Ramifications in Injury Cases

July 17, 2009 Brain Injuries

Most attorneys are familiar with the general effects of events like whiplash on a client’s back and neck. But there may be other effects of a whiplash occurrence such as rotational injury and even lack of the head impacting with an object which can result in temporary or permanent brain damage.

Although often associated with Shaken Baby Syndrome, Diffuse Axonal Injury (DAI) is a growing area of plaintiff’s personal injury law, especially in low impact cases like whiplash following an automobile accident.

DAI occurs when the white matter of the brain, which is composed of nerves called axons, is suddenly and violently shaken, twisted, or torqued in some way. Injury occurs because the unmoving brain lags behind the movement of the skull, causing brain structures to tear at a microscopic level.

x-ray_headBasically, the skull moves violently while the stationary brain stays in place, causing diffuse and sometimes extensive tearing of nerve tissue throughout the brain. This event can also cause brain chemicals to be released, causing additional injury and axonal death radiating outward from the tear. This disturbance in the brain can produce temporary or permanent widespread brain damage, coma, or death.

Most troubling for attorneys is the fact that many of these DAI injuries are not accompanied by a loss of consciousness, skull fracture or intracranial bleeding, thus the difficulty of proof at trial.

Research seems to indicate that DAI actually occurs in two phases: the stretching and tearing of the axons at impact and biochemical changes at the cellular level that may result in edema or swelling that occurs at a later time, perhaps as long as several weeks later.

The actual consequences of DAI – even those resulting in mild or moderate alteration of brain function injury – can be as catastrophic and disabling as any other type of brain injury. A person with this injury can experience a plethora of functional impairments, depending on what parts of the brain were torn in the accident. Usually the person will have changes causing irritation or agitation as a hall mark sign and the higher cognitive functions such as memory, communication, understanding and emotion can be affected globally or individually.

For attorneys, one of the more difficult aspects of a DAI case is that the damage occurs to nerves that are so subtle that the extent of the damage frequently doesn’t show up on traditional imaging such as X-Rays, CT’s or MRI scans, leaving proof of DAI in the hands of medical experts and in the hands of personal injury attorneys who have experience in this area. Newer imaging studies, while controversial, are gradually being accepted as evidence to demonstrate the presence of DAI. These include SPECT scans, PET scans, Proton Magnetic Resolution Spectroscopic Imaging, and Tensor Magnetic Resonance.

Wilson Kehoe & Winingham is open to consult with the public and attorneys seeking advice or referrals involving this complex area of practice. Our firm has extensive experience in this area of law and retains a physician-attorney and registered nurse on staff. To discuss your case please call us at 1-800-525-8028 or e-mail us at

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