During the past 10-15 years, major advances have been made in understa
nding the pathophysiologic events that occur following central nervous
system insults. It has become clear that a variety of insults have in
common their ability to initiate a complex cascade of biochemical eve
nts at the cellular level which, over time, lead to neuronal death. Be
cause these events take time to occur, interruption of these cascades
offers the hope of specific neuron-salvaging therapy, even when given
after the insult, and provides a major step forward from conventional
supportive care. This paper reviews these principles as they relate to
traumatic brain injury, with emphasis on excitatory amino acid neurot
ransmitter toxicity (excitotoxicity). Preliminary results in animal ex
periments and in severely head-injured children are discussed.