[Possibilities of cerebral monitoring]

Assessment of the level of cerebral function or of functional deficits, respectively, as in patients with acute cerebral lesions in coma, is the main purpose of cerebral monitoring. Although the clinical-neurological exploration of the patient with employment of scoring systems, such as the Glasgow Coma Scale, is the most comprehensive approach, it is of limited quantitative nature. Quantitative methods such as the EEG or evoked potentials are more objective, however, less comprehensive. Acute risks for the brain are increasingly evaluated in addition by direct or indirect measurements of the cerebral blood flow and O2 uptake, using e.g. transcranial Doppler sonography, Hb/HbO2 spectroscopy, or HbO2 saturation of cerebral venous blood for evaluation of cerebral O2 extraction. Recording of the intracranial pressure in comatose patients with severe head injury continues to play a central role in early recognition of fatal complications threatening the brain, such as an intracranial mass. Besides, assessment of the intracranial pressure is indispensable for selection of appropriate methods of treatment and adjustment of its necessary dose.