Clinical considerations in the reduction of secondary brain injury

Craniocerebral trauma renders the brain vulnerable to a variety of secondary insults that must be prevented or promptly corrected before irreversible neurologic damage occurs. These secondary insults can include hypoxia, ischemia, or both, which result in significant cell loss. The trauma-induced state of vulnerability appears to be due to cellular ionic and metabolic alterations that make up the basic physiologic sequelae after brain injury. We discuss clinical aspects regarding these potentially devastating injuries in an effort to enhance their recognition and aid in their management.