Mechanisms of Secondary Brain Damage (Nato Science Series A:)

The book is a collection of short focussed reviews on recent experimental and clinical studies related to secondary brain damage from ischemia and trauma with a spectrum reaching from molecular- and cell biological findings to the clinical management of afflicted patients. The authors are prominent experimental scientists and clinicians of various disciplines as intensive care medicine, neurology or neurosurgery. Secondary brain damage is discussed from three points of view (a) molecular- and cell biology including acidosis and inflammation, (b) novel treatment in cerebral ischemia, and (c) pathobiology, regeneration, and management in head injury. Apoptosis involving genomic activation is currently attracting great interest with regard to its role for the extinction of nerve cells from trauma and ischemia, apart from the classical mechanisms, as tissue acidosis, intracellular Ca2+-accumulation, or inflammatory processes. Further, novel concepts are presented of influencing the progressive functional deficit from brain infarction. Enhancement of the stimulatory input by the ambient environment seems to hold great promise, even though the structural tissue damage is not affected thereby. Attempts of brain grafting are so far disappointing, notwithstanding that fetal allogeneic transplants into the infarct cavity seem to be accepted and also innervated. The enormous complexity of the pathobiology of head injury is again confirmed by recent data on the cellular response of traumatized axon fibers, or on activation of the microglia. Novel findings on b-amyloid precursor protein strengthen an awesome relationship between head injury and the later development of Alzheimers's disease. Effortscontinue to design pharmacological compounds with increasing specificity to antagonize the cerebral glutamate overflow or to inhibit lipid peroxidation. Equally important are measures of the general management to reestablish cardiovascular competence in polytrauma patients with head injury. A case in point is "small volume resuscitation" in hemorrhagic shock by hypertonic/-oncotic solutions having an unmatched potential to normalize cardiac output. The complex requirements of patient management in head injury has on an international level stimulated the formation of study groups for the elaboration of standards and guidelines including for controlled clinical trials. Illustrative examples are the foundation of the American and European Brain Injury Consortium.