Severe traumatic brain injury

The restitution of brain function and successful achievement of good neurological outcome after acute brain injury, including severe traumatic brain injury and other encephalopathies, represents the final frontier in critical care medicine. Related to the complexity of the brain and the difficulties involved in the bedside assessment and monitoring of cerebral pathophysiology; progress in this area has been disappointing, and therapeutic breakthroughs are generally lacking. Severe traumatic brain injury, however, represents one of the most likely diseases in neurointensive care in which breakthroughs may soon be achieved. This results from the fact that in many cases, traumatic brain injury afflicts young and otherwise healthy patients. Similarly, unlike the encephalopathies of cardiopulmonary arrest and asphyxia, severe traumatic brain injury is often focal in nature. In the setting of focal injury in a relatively young and otherwise healthy patient, the successful management of the evolution of damage, along with the prevention of secondary insults and herniation, through optimal neurointensive care, can set the stage for progressive improvement in outcome as a consequence of cerebral plasticity.