Acute traumatic brain injuries and their management

Traumatic brain injuries (TBIs) represent the leading cause of death and morbidity in western countries. Since motor vehicle accidents are the leading cause of significant trauma, TBIs affect mostly young adults with increasing incidence and are responsible for a major social and economic burden. For decades, the mainstay of neurotrauma management has been represented by control of posttraumatic edema and raised intracranial pressure (ICP). With the emergence of a better understanding of the underlying cellular mechanisms responsible for the generation of secondary brain damage, the hope for the “magic bullet” has prompted the development of novel drugs. Encouraged by the promising results of basic research studies, clinical trials were initiated in an increasing number up to the mid-1990s. However, the high expectations raised by convincing laboratory data were not met by deceiving results that made pharmaceutical industry reluctant to support high-cost adventurous research that have repeatedly failed to significantly improve outcome of head-injured patients. Accordingly, the management of neurotrauma has focused back on optimization of neurointensive care and surgical treatment.