Intracranial hypertension after traumatic brain injury

Introduction Traumatic brain injury (TBI) is a common and devastating problem with a high mortality and a high residual morbidity in survivors. The most cost effective measures of course are all preventative, including public health education, the mandatory use of seatbelts in cars and helmets on motorcycles, appropriate speed limits and improved road design. When an injury has occurred, however, it then becomes crucial for the prehospital and hospital management to be focused on preventing secondary injury and minimizing the chances of a poor outcome. In the neurointensive care unit the issue above all else is to maintain cerebral perfusion and prevent cerebral ischaemia. Intracranial hypertension leads to cerebral ischaemia and is often the most difficult management problem after a head injury. It is disappointing that while intracranial hypertension was identified as the prime pathophysiological entity in TBI in 1951, there are still few therapeutic options available to the clinician and the overall quality of research is poor.