Clinical neuroprotection and secondary neuronal injury mechanisms

Abstract 

Anaesthetists and intensive care physicians commonly encounter brain injuries in their clinical practice. Cerebral insults may arise from traumatic brain injury, may follow cardiothoracic, vascular or major orthopaedic surgery, and are seen in medical conditions including subarachnoid haemorrhage, central nervous system infection, epilepsy and stroke. In all cases, neuronal injury may lead to severe disability or death; however, aggressive early treatment to prevent the mechanisms that lead to irreversible ischaemia and neuronal cell destruction can result in improvements in patient morbidity and mortality. Neuroprotection involves intervention initiated before the onset of an ischaemic event in an attempt to modify the cascade of biological events that follow ischaemia and thus limit permanent cell damage. Neuroresuscitation, on the other hand, refers to treatment aimed at restoring blood flow to cells that have already become exposed to an ischaemic insult.

Keywords: cerebral protection, secondary brain injury, stroke, subarachnoid haemorrhage, traumatic brain injury