Secondary Brain Injury: Prevention and Intensive Care Management

Abstract

Head Injury is one of the commonest causes of death. Most are the result of road traffic accidents. Primary Brain injury is the damage sustained as a direct result of the impact on the skull and intracranial contents. Secondary brain injury refers to the changes that evolve over a period of time (from hours to days) after the primary brain injury. It includes an entire cascade of cellular, chemical, tissue, or blood vessel changes in the brain that contribute to further destruction of brain tissue1. The purpose of this article is to outline the importance in early diagnosis and aggressive treatment of secondary brain injury so that further damage to brain can be prevented.

Keywords

Brain injury - secondary Brain Injury - Intensive care

• References

• 1 Gentleman D. Causes and effects of systemic complications among severely injured patients transferred to a neurosurgical unit. Int Surg 72 1992; 297-302
• 2 Chestnut RM, Marshall SB, Piek J. et al Early and late systemic hypotension as a frequent and fundamental source of cerebral ischemia following severe brain injury in the Traumatic Coma Data Bank. Acta Neurochir (Wien) Suppl 59 1993; 121-125
• 3 Marmarou A, Anderson RL, Ward JD. et al Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 75 1991; 59-66
• 4 Chesnut RM, Marshall SB, Pick J. et al Early and late systemic hypotension as a frequent and fundamental source of cerebral ischaemia following severe brain injury in the Traumatic Coma Data Bank. Acta Neurochir (Wien) Suppl 59 1993; 121-125
• 5 Seisjo BK. Pathophysiology and treatment of focal cerebral ischemia. Part II: Mechanisms of damage and treatment. J Neurosurg 77 1992; 337-354
• 6 Klatzo I. Pathophysiological aspects of brain edema. Acta Neuropathol 72 1987; 236-239
• 7 Globus MY, Alonso O, Dietrich WD. et al Glutamate release and free radical production following brain injury: effects of post-traumatic hypothermia. J Neurochem 65 1995; 1704-1711
• 8 Belayev L, Busto R, Zhao W. et al HU-211, a novel noncompetitive NMDA antagonist, improves neurological deficit and reduces infarct volume after reversible focal cerebral ischemia in the rat. Stroke 26 1995; 2313-2320
• 9 Karibe H, Chen SF, Zarow GJ. et al Mild intraischemic hypothermia suppresses consumption of endogenous antioxidants after temporary focal ischemia in rats. Brain Res 649 1994; 12-18
• 10 Shohami E, Gallily R, Mechoulam R. et al Cytokine production in the brain following closed head injury: dexanabinol (HU-211) is a novel TNF-a inhibitor and an effective neuroprotectant. J Neuroimmunol 72 1997; 169-177
• 11 Cruz J, Minoja G, Okuchi K. Improving clinical outcomes from acute subdural hematomas with the emergency preoperative administration of high doses of mannitol: a randomized trial. Neurosurgery 49 2001; 864-871
• 12 Rosner MJ, Daughton S. Cerebral perfusion pressure management in head injury. J Trauma 30 1990; 933-941
• 13 Piatt JH, Schiff SJ. High dose barbiturate therapy in neurosurgery and intensive care. Neurosurgery 15 1984; 427-444
• 14 Boarini DJ, Kassell NF. et al comparison of systemic and cerebral vascular effects of isoflurane and halothane. Neurosurgery 15 1984; 400-409
• 15 Muizelaar JP, Marmarou A, Ward JD. et al Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg 75 1991; 731-739
• 16 Wise BL, Chater N. The value of hypertonic mannitol solution in decreasing brain mass and lowering cerebrospinal fluid pressure. J Neurosurg 19 1962; 1038-1043
• 17 Hartl R, Medary MB, Ruge M. et al Hypertonic/hyperoncotic saline attenuates microcirculatory disturbances after traumatic brain injury. Trauma 42 (Suppl. 05) 1997; S41-S47
• 18 Vialet R, Albanese J, Thomachot L. et al Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2 ml/kg 7.5% saline is more effective than 2 ml/kg 20% mannitol. Crit Care Med 31 2003; 1683-1687
• 19 Alderson P, Roberts I. Corticosteroids in acute traumatic brain injury: a systematic review of randomized trials. BMJ 314 1997; 1855-1859
• 20 Rosner MJ. Introduction to cerebral perfusion pressure management. Neurosurg Clin N Am 06 1995; 761-763
• 21 Robertson CS. Management of cerebral perfusion pressure after traumatic brain injury. Anesthesiology 95 (06) 2001; 1513-1517
• 22 Gupta AK, Al-Rawi PG, Hutchinson PJ. et al Effect of hypothermia on brain tissue oxygenation in patients with severe head injury. Br J Anaesth 88 2002; 188-192
• 23 Aibiki M, Maekawa S, Ogura S. et al Effect of moderate hypothermia on systemic and internal jugular plasma IL6 levels after traumatic brain injury in humans. J Neurotrauma 16 1999; 225-232
• 24 Clifton GL, Miller ER, Choi SC. et al Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 344 2001; 556-563
• 25 Keening KL, Unterberg AW, Bardt TF. et al Monitoring of cerebral oxygenation in patients with severe head injury: Brain tissue PO2 versus jugular vein oxygen saturation. J Neurosurg 85 1996; 751-757