Head injury: Recent past, present, and future

THERE IS NO question that substantial progress has been made over the last 30 years, since the pioneering multinational studies of Jennett and colleag ues, in our understanding of the mechanisms involved in the production, pro gression, and amelioration of brain damage. The introduction of computed to mography and simple but elegant classifications of the severity of injury ( e.g., the Glasgow Coma Scale and the Glasgow Outcome Scale) were seminal mi lestones in neurotraumatology. When neurosurgeons such as Langfitt, Pecker, and Miller took advantage of the pioneering investigations of intracranial hypertension by Janny and Lundberg and combined them with imaging, classif ication of brain damage, and improvements in emergency medical services, su bstantial gains were soon made. However, given the perspective of the begin ning of the 21st century, one can see those gains as relatively straightfor ward, as they have required the consolidation of concepts and ideas that li t together relatively easily. Better attention to easily delineated abnorma lities, such as shock, hypoxia, and hypercarbia, and the early evacuation o f mass lesions coupled with the concurrent development of modern principles of critical care account for substantial reductions in mortality and a red uction in the number of vegetative, contracted, spastic survivors. Future i mprovement in the care of patients with head injuries will increasingly be dependent on advances in molecular neurobiology and psychology, our ability to successfully modulate genetic expression, and progress in the treatment of related illnesses, such as stroke, subarachnoid hemorrhage, depression, and Alzheimer's disease.