[Neurotrauma in treatment of nervous system injuries--principles in cooperating with anesthesiologists]

After brain trauma neuronal degeneration results due to the combination of primary mechanical disruption of CNS parenchyma and the secondary pathophysiological events. The fact that the treatment can modified the clinical course and the final outcome, implies that is indeed a modifiable secondary neurodegenerative process which is caused by the mechanical injury. Contemporary in patients with craniocerebral trauma and with polytrauma our management is focused on prevention of secondary brain injury. On the accident scene that is crucial to appropriate ventilate the patient, stabilize blood pressure and prevent shock. The diagnostic tool of choice is CT, but made in the very early stage could revealed false negative scan. That could be the cause of missed beginning of intracranial pressure increase in artificially ventilated patients. Multimodality monitoring in highly specialized centers could enable early detection of such increase (ICP) and help in estimation of indication for surgical treatment. The mechanism, direct sequelae of head trauma and neurological symptoms dynamics are also important.