CLINICAL AND PATHOPHYSIOLOGICAL SIGNIFICANCE OF SEVERE NEUROTRAUMA INPOLYTRAUMATIZED PATIENTS

Introduction. Traumatic brain injury (TBI) is present in up to two-thi rds of multiply injured patients. The degree of TBI influenced the mor tality and morbidity of multiple trauma significantly. Results: Import ant prognostic predictors are: injury severity score (ISS); Glasgow co ma score [(GCS), motor score]; pupil size and reactivity; coma grade a nd duration; age; morphological primary brain lesion; and pathophysiol ogical changes leading to secondary brain damage. The time course of b rain edema, raised intracranial pressure and, especially, pathophysiol ogy of disturbed cerebral blood flow and metabolism characterizes earl y and late periods of ischemic vulnerability. Conclusion: These should be taken into consideration when planning operative procedures in mul tiple-trauma patients. Avoidance of secondary ischemic brain damage by reducing the number of systemic insults (hypovolemia, hypotension, hy poxia) will improve prognosis of critically ill polytraumatized patien ts with head injury.