Brain injury clinical management

Perino C, Rago R, Cicolin A, et al. Mood and behavioural disorders following traumatic brain injury clinical evaluation and pharmacological management. Brain Injury 2001 15(2) 139-148. 

Resurgence of Hypothermia as a Treatment for Brain Injury. The Effects of Hypothermia and Hyperthermia in Global Cerebral Ischemia. Mild Hypothermia in Experimental Focal Cerebral Ischemia. Hypothermic Protection in Traumatic Brain Injury. Postischemic Hypothermia Provides Long-Term Neuroprotection in Rodents. Combination Therapy With Hypothermia and Pharmaceuticals for the T reatment of Acute Cerebral Ischemia. Intraoperative and Intensive Care Management of the Patient Undergoing Mild Hypothermia. Management of Traumatic Brain Injury With Moderate Hypothermia. Hypothermia Clinical Experience in Stroke Patients. Hypothermia Therapy Future Directions in Research and Clinical Practice. Index. 

The clinical management of brain injury includes the use of osmotic and other diuretics to attempt to control tissue edema and agents which modify the rheology of blood in order to better perfuse the brain and counter ischemia. Two recent reports summarize the effects of hemodilution with DCLHb or oncotically... 

Guidelines for the Management of Severe Brain Injury, pub-lished by the Brain Trauma Foundation/American Associa-tion of Neurological Surgeons, serves as the foundation on which clinical decisions in managing adult neurotrauma patients are based comparable guidelines for infants, children, and adolescents also have been published recently. 

The intent of this chapter is not to discuss the various pathogens and their varied manifestations of brain injury, but specific patterns of pathogenesis to the extent of our understanding and the mechanisms that lead to brain dysfunction during infection or inflammation. Needless to say, the specific mechanisms of brain injury in these disorders are poorly understood in most instances, and some hypotheses are just that, hypotheses without evidence to support the theory. The focus of discussion will be on the pathogenesis and mechanisms of brain dysfunction. The reader is referred to in-depth discussions on symptoms and treatment to appropriate articles that focus on the clinical management of these disorders. 

McCrea, M., Iverson, G.L., McAllister, T.W., et al., 2009. An integrated review of recovery after mild traumatic brain injury (MTBI) implications for clinical management. Qin. Neuropsychol. 23 (8), 1368-1390. 

TBI is often divided into two distinct but related phases primary brain injury and secondary insults (Werner and Engelhard, 2007 Greve and Zink, 2009). Clinically, primary brain injury often requires surgical attenhon, whereas secondary injury is managed in the intensive care setting, where the prevention and treatment of these secondary insults become tire major focus of neurotrauma intensivists. Primary brain injury happens at the hme of the inihal mechanical impact to the skull. 

The concept of the ischemic penumbra has proven to be an extremely valuable construct for both experimental studies of ischemic stroke and for the development of tools for the management of patients with this disorder. Indeed, a major driver in the development of treatments for ischemic stroke is the belief that in many acute stroke patients, there is a region of salvageable brain that is threatened with permanent injury. This region of brain corresponds to the ischemic penumbra originally described in experimental stroke studies. The clinical condition does not strictly meet the criteria as originally defined by experimentalists. Nonetheless, the concept is clinically valuable, and a suitable modification of its definition applicable to the clinical condition is appropriate. 

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