16    Diffuse Axonal Injury

Diffuse axonal injury (DAI) is the most common parenchymal injury occurring in trauma, and results from acceleration–deceleration or rotational force injuries. In these injuries, force differentials in adjacent areas of brain result in axonal shearing. DAI is staged by lesion location. Stage 1 lesions have the best prognosis and occur in the lobar white matter, usually at the gray–white matter junction (Figs. 16.1A,B). Stage 2 lesions involve the corpus callosum (Fig. 16.1C, black arrow), most commonly in the splenium and posterior portions. This pattern is related to the relatively narrow anterior falx, which allows for transient hemispheric herniation in lieu of axonal shearing. Stage 3 DAI is the most severe and involves the brainstem (Fig. 16.1D

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