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British Journal of Anaesthesia 2007 99(1):4-9; doi:10.1093/bja/aem131
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Pathophysiology of traumatic brain injury

C. Werner* and K. Engelhard

Klinik für Anästhesiologie, der Johannes Gutenberg-Universität Mainz, Langenbeckstrasse 1, D-55131 Mainz, Germany

* Corresponding author. E-mail: werner{at}anaesthesie.klinik.uni-mainz.de

The knowledge of the pathophysiology after traumatic head injury is necessary for adequate and patient-oriented treatment. As the primary insult, which represents the direct mechanical damage, cannot be therapeutically influenced, target of the treatment is the limitation of the secondary damage (delayed non-mechanical damage). It is influenced by changes in cerebral blood flow (hypo- and hyperperfusion), impairment of cerebrovascular autoregulation, cerebral metabolic dysfunction and inadequate cerebral oxygenation. Furthermore, excitotoxic cell damage and inflammation may lead to apoptotic and necrotic cell death. Understanding the multidimensional cascade of secondary brain injury offers differentiated therapeutic options.

Keywords: brain, cerebral blood flow; complications, vasospasm; head, trauma; inflammation; pathophysiology


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