Experimental and clinical main forms of hypoxic-ischaemic brain damage and their monitoring

A short review of main pathogenetic forms of hypoxic-ischaemic brain damage and its consequences for causally orientated therapy and monitoring is given. Different pathogenetic components act in several combinations. In these processes disturbances of the cardio-vascular system, of the haemorheology mainly at the level of microvessels, and disturbances of the blood brain barrier are involved. Furthermore, there are relevant disturbances of the neuronal metabolism such as accumulation of cytosolic Ca++ or disturbances caused by the effect of radicals, lipid peroxidation and changes of protein synthesis. Nowadays, chances of a cause-related therapy are increased by improved evaluation of main pathogenetic components especially regarding secondary brain damage. To evaluate these components in detail, animal models must be more clinically related, especially regarding long-term studies. The increasing knowledge about critical thresholds of reversible and irreversible brain changes also favours effective cerebral function monitoring. The main conclusions from previous experimental as well as clinically related studies indicate the necessity of very early therapeutical interventions.