PATHOPHYSIOLOGIC CONSEQUENCES OF BLOOD-BR AIN-BARRIER BREAKDOWN

Most of the adverse effects of cerebral injury derive result from the formation of cerebral oedema, which causes brain swelling, brain shift and intracranial hypertension. The mechanisms of cerebral oedema are specific of the type of cerebral injury and the effectiveness of treat ments such as corticosteroids depend on the type of cerebral oedema. R ecent magnetic resonance imaging studies of the brain in patients with acute intracranial injury have confirmed that anatomical brain shifts accompagny the clinical syndromes of brain herniation. In particular, specific neurological syndromes can effectively identify rostro-cauda l herniation, both transtentorially (uncal and central syndrome) and t hrough the foramen magnum. Signs of upward transtentorial herniation a re less specific. Early detection of these syndromes is essential if t herapeutic measures to reduce intracranial pressure are to be taken be fore secondary neurological injury occurs.