Davceva Natasha, Basheska Neli, Balazic Joze
From the Faculty of Medicine, Skopje, Macedonia, The Former Yugoslav Republic of.
Am J Forensic Med Pathol. 2015 Sep;36(3):127-33. doi: 10.1097/PAF.0000000000000168.
The knowledge about the diffuse axonal injury (DAI) as a clinicopathological entity has matured in the last 30 years. It has been defined clinically (immediate and prolonged unconsciousness leading to death or severe disability) and pathologically (the triad of DAI specific changes). In terms of its biomechanics, DAI is occurring as a result of acceleration forces of longer duration and has been fully reproduced experimentally.In the process of diagnosing DAI, the performance of a complete forensic neuropathological examination is essential and the immunohistochemistry method using antibodies against β-amyloid precursor protein (β-APP) has been proved to be highly sensitive and specific, selectively targeting the damaged axons.In this review, we are pointing to the significant characteristics of DAI as a distinct clinicopathological entity that can cause severe impairment of the brain function, and in the forensic medicine setting, it can be found as the concrete cause of death. We are discussing not only its pathological feature, its mechanism of occurrence, and the events on a cellular level but also the dilemmas about DAI that still exist in science: (1) regarding the strict criteria for its diagnosis and (2) regarding its biomechanical significance, which can be of a big medicolegal importance.
在过去30年里，关于弥漫性轴索损伤（DAI）作为一种临床病理实体的认识已经成熟。它在临床上被定义为（即刻和持续性昏迷导致死亡或严重残疾），在病理上被定义为（DAI特异性改变三联征）。就其生物力学而言，DAI是由较长持续时间的加速力导致的，并且已经在实验中得到充分再现。在诊断DAI的过程中，进行完整的法医神经病理学检查至关重要，并且使用抗β-淀粉样前体蛋白（β-APP）抗体的免疫组织化学方法已被证明具有高度敏感性和特异性，可选择性地靶向受损轴突。在这篇综述中，我们指出DAI作为一种独特的临床病理实体的显著特征，它可导致严重的脑功能损害，在法医学领域，它可作为具体的死亡原因。我们不仅讨论其病理特征、发生机制和细胞水平的事件，还讨论科学上关于DAI仍然存在的困境：（1）关于其诊断的严格标准，以及（2）关于其生物力学意义，这可能具有重大的法医学重要性。
