Diffuse Axonal Injury


Diffuse axonal injury (DAI), is a traumatic brain injury that develops after the brain quickly shifts within the skull, such as when the body is shaken. This force causes axons in the brain to tear, causing a disruption in communication between the nerves in the brain, which can then lead to coma pr physical and cognitive impairment.


  • Confusion
  • Diminished balance
  • Drowsiness
  • Excessive fatigue or sleepiness
  • Headache
  • Nausea or vomiting
  • Sleep issues


Because diffuse axonal injury is a type of traumatic brain injury, taking steps to protect the head and brain is important. Protect the head using a helmet during sports participation and while riding a motorcycle, practice fall prevention techniques, wear a seatbelt and avoid shaking others, even playfully.

Risk Factors

  • Abusive relationship or history of domestic abuse
  • Being older and more likely to fall
  • Sports participation


  • Medical history and symptom review. Diffuse axonal injury often results in a person being unable to communicate effectively or in a coma, so a medical provider will talk through what’s happening with a spouse or other person who was present at the time of injury. 
  • Physical examination. This review of symptoms is followed by a comprehensive medical examination, looking at areas of impact on the body.
  • Additional testing. Because diffuse axonal injury is a traumatic brain injury, visible exterior symptoms may not be present. A medical provider will order diagnostic imaging tests to examine the injured parts of the brain, but in many cases the changes related to DAI are tiny and may not be visible.


  • Diffuse axonal injury can cause cerebral edema and elevated intracranial pressure, so the first line of treatment often includes the alleviation of swelling. Treatment may include oral medications such as steroids or techniques to reduce swelling and fluid levels in the brain.
  • In mild to moderate cases, similar to what’s experienced with a concussion, a patient’s recovery process will initially include a period of rest followed by intensive rehabilitation.
  • In many cases, DAI leads to a vegetative state or death. If the patient regains consciousness, rehabilitation will be required to help him or her regain functional abilities. The rehabilitation program, which is dependent on the individual patient’s needs and deficits left after brain injury, will likely include a combination of speech, physical, recreational and occupational therapies, along with training to use adaptive equipment.

Follow-up Care

  • In cases of severe diffuse axonal injury, long-term care and rehabilitation may be required.
  • For mild to moderate cases, a medical provider will prescribe a comprehensive care plan that will likely include ongoing rehabilitation.
  • In addition to rehabilitation, this care plan will also include recurring follow-up appointments to review symptoms and adapt treatment and rehabilitation depending on recovery and patient needs.