Medical management of head injury and neuroprotection

Head injury continues to cause significant mortality and morbidity despite the advances in early and late management and rehabilitation techniques. The extent and prognosis of brain injury are influenced by the primary impact and initiation of secondary mechanism. Outcome is also dependent on resuscitation and maintenance of cerebral oxygenation. The initial management is aimed at preventing secondary brain injury and identifying those patients who may benefit from surgical intervention. Continuing care is based on the careful and timely transfer to the appropriate intensive care environment where maintenance and monitoring of cerebral oxygenation are used. A variety of techniques involving the manipulation of both cerebral perfusion pressure and intracranial pressure are employed. There are a number of, as-yet, unproven techniques under examination for affecting cerebral metabolism to provide a degree of protection against further damage.