Pathophysiology of brain insult. Therapeutic implications with the Lund Concept

This paper describes some major implications of brain insult following trauma or intracerebral haemorrhage for the development of brain oedema and compromised microcirculation. Secondary insults such as an increase in intracranial pressure and development of contusion and penumbra zone areas, as well as their bearing on outcome, are discussed. A therapeutic protocol is presented which aims at keeping intracranial volume within acceptable limits by counteraction of interstitial brain oedema, reduction in intracerebral blood volume, and improvement of microcirculation around contusions. This ICP-targeted therapy, called the "Lund Concept", for treatment of severe head injury has resulted in marked reduction in mortality following brain trauma.