[New developments and perspectives of intensive neurology]

In the last few years considerable advances have been made in the diagnosis and treatment of cerebrovascular diseases, neurotrauma, and infections or inflammatory diseases of the CNS. Although thrombolysis of medial cerebral artery infarction and craniotomy with dural replacement plastic in space-occupying medial cerebral artery infarction only concern a minority of "patients with acute cerebral infarction", these treatment strategies have now been accepted as justifiable methods in the acute management of vascular ischaemic cerebral events. In addition to invasive and non-invasive monitoring of intracranial pressure and perfusion pressure in acute craniocerebral injuries, the therapeutic possibilities include treatment with calcium antagonists in traumatic subarachnoid haemorrhage and early recognition of space-occupying hemorrhagic brain contusions, in particular those mainly concerning the frontal portion of the brain. In the last few years, remarkable progress has also been made in understanding the pathophysiology of intracranial processes in bacterial meningitis. In addition to consecutive monitoring and management strategies, it is now possible to make prognostic statements and to propose adjuvant treatment strategies based on pathophysiological variables. In the therapeutic management of most severe intensive neurological disorders (spontaneous subarachnoid haemorrhage, craniocerebral trauma, dexamethasone in bacterial meningitis, etc.), a series of carefully conducted prospective randomised double-blind studies are currently under way. Hence, further significant advancements in the understanding of pathophysiology, in diagnostic and prognostic measurements and, in particular, the application of causal and adjuvant treatment strategies, are anticipated in the near and nearest future.