Can Secondary Brain Damage be Prevented by Pharmacological or other Means?

  • Lawrence F. Marshall
Part of the NATO ASI Series book series (NSSA, volume 115)


Modern treatment of severe brain injury has centered on the hospital phase with neurosurgeons and others providing intensive care devoting much of their attention to the treatment of intracranial hypertension. This is appropriate since approximately 55% of severely head injured patients reaching the hospital alive will have an ICP in excess of 30 mmHg at some time during their intensive care. However, it is important to recognize that treatment of secondary insults to the already injured brain can not only reduce the number of patients who die prior to hospitalization, but may also reduce the incidence of elevated ICP, the most frequent cause of death in the severely head injured. Harr et al., have shown that severe hypoxia in the pre-hospital phase was associated with a substantially increased risk of elevated ICP during hospitalization (1). One might therefore conclude that early treatment of hypoxia should reduce the incidence of intracranial pressure rises and thus decrease mortality.


Intracranial Hypertension Cerebral Vasospasm Severe Head Injury Acute Brain Injury Severe Brain Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Harr FL, Phillips S, Huchton JI, The incidence and significance of early hypoxemia in head injury patients, Trans Amer Assoc Neurosurg, Boston ( 1981.Google Scholar
  2. 2.
    Klauber MR, Marshall LF, Toole BM, Knowlton SL, and Bowers S.A., Cause of decline in head-injury mortality rate in San Diego County, California, J Neurosurg 62: 528 (1985).CrossRefGoogle Scholar
  3. 3.
    Miller JD, Sweet RC, Narayan R, Becker DP, Early insults to the injured brain. JAMA 240: 439 (1978).CrossRefGoogle Scholar
  4. 4.
    Wurtman RJ, Zervas NT, Monoamine neurotransmitters and the pathophysiology of stroke and central nervous system trauma. J Neurosurg 40: 34 (1974).CrossRefGoogle Scholar
  5. 5.
    Clifton GL, Ziegler MG, Grossman RG, Circulating catecholamines and sympathetic activity after head injury, Neurosurgery 8: 309 (1981).CrossRefGoogle Scholar
  6. 6.
    Shalit MN, Cotev S, The cushing response — a compensatory mechanism or a dangerous phenomenon? in: “ICP II”, Lundberg N, Ponten U, Brock M, eds., Springer Verlag, Berlin (1975).Google Scholar
  7. 7.
    Clifton GL, Robertson CS, Kyper K, Taylor AA, Dhekne RD, Grossman RG, Cardiovascular response to severe head injury, J Neurosurg 59: 447 (1983).CrossRefGoogle Scholar
  8. 8.
    Robertson CS, Clifton GL, Taylor AA, Grossman RG, Treatment of hypertension associated with head injury, J Neurosurg 59: 455 (1983).CrossRefGoogle Scholar
  9. 9.
    Myers RE, Lactic acid accumulation as a cause of brain edema and cerebral necrosis resulting from oxygen deprivation. in: “Advances in perinatal neurology”, Korobskin R, Guilleminault G, eds., Spectrum Publishers, New York (1977).Google Scholar
  10. 10.
    Rehncrona S, Rosen I, Siesjö BK, Excessive cellular acidosis: An important mechanism of neuronal damage in the brain? Acta Physiol Scand 110: 435 (1980).CrossRefGoogle Scholar
  11. 11.
    Rapp RP, Young B, Tayman D, Birins BA, Haack D, Tibbs PA, Bean JR, The favorable effect of early parenteral feeding on survival in head injured patients, J Neurosurg 58: 906 (1983).CrossRefGoogle Scholar
  12. 12.
    Marshall LF, Barba D, Toole BM, Bowers SA, The oval pupil: Clinical significance and relationship to intracranial hypertension, J Neurosurg 58: 566 (1983).CrossRefGoogle Scholar
  13. 13.
    Bellegarrigue R, Ducker RB, Control of intracranial pressure in severe head injury, in: “ICP V”, Ishii S, Nagai H, Brock M, eds., Springer Verlag, Berlin (1983).Google Scholar
  14. 14.
    Klauber MR, Toutant SM, Marshall LF, A model for predicting delayed intracranial hypertension following severe head injury (submitted)Google Scholar
  15. 15.
    MacPherson P, Graham DI, Correlation between angiographic findings and the ischemia of head injury, J Neurol Neurosurg Psychiat 41: 122 (1978).CrossRefGoogle Scholar
  16. 16.
    Bedford RF, Dacey R, Winn HR, Lynch C III, Adverse impact of a calcium entry blocker (verapamil) on intracranial pressure in patients with brain tumors, J Neurosurg 59: 800 (1983).CrossRefGoogle Scholar

Copyright information

© Plenum Press, New York 1986

Authors and Affiliations

  • Lawrence F. Marshall
    • 1
  1. 1.Division of NeurosurgeryUniversity of California Medical CenterSan DiegoUSA

Personalised recommendations