Clinical and pathophysiological significance of severe neurotrauma in polytraumatized patients.
BACKGROUND
Traumatic brain injury (TBI) is present in up to two-thirds of multiply injured patients. The degree of TBI influenced the mortality and morbidity of multiple trauma significantly.


RESULTS
Important prognostic predictors are: injury severity score (ISS); Glasgow coma score [(GCS), motor score]; pupil size and reactivity; coma grade and duration; age; morphological primary brain lesion; and pathophysiological changes leading to secondary brain damage. The time course of brain edema, raised intracranial pressure and, especially, pathophysiology of disturbed cerebral blood flow and metabolism characterizes early and late periods of ischemic vulnerability.


CONCLUSIONS
These should be taken into consideration when planning operative procedures in multiple-trauma patients. Avoidance of secondary ischemic brain damage by reducing the number of systemic insults (hypovolemia, hypotension, hypoxia) will improve prognosis of critically ill polytraumatized patients with head injury.
Meixensberger
J
J
Neurochirurgische Klinik und Poliklinik, Universität Würzburg, Germany.
Roosen
K
K
D001929:Brain Edema / Q000209:etiology; D001930:Brain Injuries / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D007427:Intracranial Pressure; D009104:Multiple Trauma / Q000503:physiopathology* / Q000628:therapy