Daño axonal difuso: Importancia de su diagnóstico en neuropatología forense

Abstract

The term diffuse axonal injury (DAI) refers to the clinical syndrome presented in the traumatic prolonged comas and the subsequent pathological substrate which can be also due to other non-traumatic aetiologies. Some alterations which can give information about the nature of injuries are difficult or even impossible to appreciate in the macroscopical examination. Independent of the cause, the important data is that the surviving period must be superior to 3 hours. The seriousness of the clinical syndrome and the prognostic depends on the total number and localization of injured axons. DAI is an histological diagnosis, however the histological evidence is not enough to talk about the existence of DAI. The first appreciable axonal alteration is the presence of spheroids or "axonal balls" which corresponds ultra structurally with locally dilated axons with accumulate of organelles and disarray of cytoskeleton. The intensity of the affectation depends on the magnitude, the time and the axis of acceleration in the case of cranial traumatisms. The axonal transportation it's made through microtubules in the sense that trauma breaks the web of neurofilaments and microtubules which configures the cytoskeleton, or it determines a neurochemical intra axonal alteration with the same consequences, or alter the axolema driving to a local ionic deregulation which also may deteriorate the axonal transportation. Based upon the intensity of the injury, proteins of the axonal cytoskeleton could aggregate or compact always ending in the disarray but with a different temporary cadence. Key words: diffuse axonal injury, diffuse vascular