CEREBRAL HEMODYNAMICS AND INTRACRANIAL HY PERTENSIONS

Various cerebral aggressions, either primary or secondary, can lead to the development of raised intracranial pressure. The presence of an e levated intracranial pressure often results in cerebral ischaemia/hypo xia and, eventually, neuronal death. In face of this cascade of events , several therapeutic approaches have been suggested. Two management c oncepts for patients with raised intracranial pressure have retained t he most attention in recent years: the first suggests a therapeutic in crease in cerebral perfusion pressure with the objectives to improve p erilesional collateral perfusion and decreased cerebral blood volume, and consequently intracranial pressure in areas where autoregulation i s preserved. The second concept supports the diminution in perilesiona l capillary pressure with the aim of decreasing vasogenic oedema. Alth ough these two concepts are antagonistic and cannot be used simultaneo usly, they are probably complementary in the sequence of therapeutic e vents of patients experiencing severe head injury. This article review s these therapeutic concepts and their clinical applications.