Neurochemical monitoring of the acutely injured human brain

The main goal of modern neurointensive care (NIC) of patients with acute br ain injury (traumatic brain injury, neurovascular disease) is to prevent ad ditional loss of viable brain tissue due to secondary injury processes. It is generally held that secondary injury, mediated by, for example, cerebral hypoxia/ischemia and destructive molecular cascades on the cellular level, contributes significantly to the extent of brain damage after head injury and stroke. The basic concept is that improved knowledge of the secondary i njury processes will lead to new therapeutic approaches in NIC. New methods by which secondary injury processes can be detected and monitored in NIC p atients are therefore greatly needed. This paper describes intracerebral microdialysis as a novel approach to neu rochemical monitoring of the human brain. The main objectives are (i) to mo nitor cortical energy metabolism in order to detect secondary ischemia and (ii) to monitor secondary injury processes, such as glutamate receptor over activation and increased free radical production, in MC patients.