Traumatic brain ischemia during neuro intensive care: myth rather than fact

In non-missile severe acute brain trauma, brain ischemia was a frequent finding in cadavers. Studies during neuro intensive care, however, have failed to disclose brain ischemia under most circumstances, except when cerebral hemodynamic and metabolic parameters have been misinterpreted, or when cerebral blood flow (CBF) alone has been addressed in a biased fashion, without mandatory metabolic data. Indeed, comprehensive and unbiased studies focusing on global cerebral metabolic activity have invariably revealed a condition of normal coupling between reduced CBF and oxygen consumption in the early postinjury hours, which is then followed by a prolonged, sustained pattern of relative cerebral hyperperfusion (the opposite of ischemia). Accordingly, traumatic brain ischemia during intensive care represents myth rather than fact.