A distinction between primary and secondary brain damage of vari­ ous origin, particularly in acute lesions, such as head injury and ische­ mia is not entirely new. The concept is of practical significance, be­ cause it is the foremost intention of all clinical efforts to prevent, or at least attenuate the development of secondary sequelae. Primary dam­ age to nervous elements usually cannot be influenced by treatment. Its prevention is the objective of prophylactic measures. The current volume gathered prominent scientists and clinicians from various fields to pro­ vide a competent introduction and survey of the various aspects involved in secondary brain damage. It was attempted to provide criteria for the distinction between the primary and secondary phenomena on a morpho­ logical and functional level, on the basis of the kinetics involved and, most importantly, regarding the different specific manifestations, such as disturbances of microcirculation, aspects of the blood-brain barrier, and of cellular structure and function at a molecular level. Although it was not expected that a grand unifying hypothesis will be reached recon­ cilable with the many, occasionally opposing views on such a complex subject, nevertheless, the present volume attains an appropriate result. It can best be described as a mosaic of many different pieces which only as an ensemble reflect the current state of the art.

Inhalt

I. Neuropathology of Primary and Secondary Brain Damage.- a) Head Injury.- Primary Brain Damage in Non-Missile Head Injury.- Diffuse Axonal Injury - A New Conceptual Approach to an Old Problem.- Histopathology and Computerized Tomography of Human Traumatic Cerebral Swelling.- The Temporal Genesis of Primary and Secondary Brain Damage in Experimental and Clinical Head Injury.- b) Cerebral Ischemia.- Evolution of Neuronal Ischemic Injury.- Secondary Changes in Human and Experimental Brain Infarction with Particular Consideration of Microembolism.- Ischemic Brain Damage in the Rat in a Long Term Recovery Model.- Microthrombosis: A Contributing Factor to the Progression of Cerebral Infarction in Man.- The CT Normal but Low Flow Infarct Periphery: Selective Neuronal Necrosis?.- II. Pathophysiological and Biochemical Mechanisms.- a) Cerebral Edema.- Disturbances of Extracellular Homeostasis after a Primary Insult as a Mechanism in Secondary Brain Damage.- Role of Mediator Compounds in Secondary Brain Damage - Current Evidence.- Neurochemical Sequelae of Brain Damage and their Role in Functional Disturbances.- Changes in Brain Edema Movement Following Experimental Brain Insults and Acute Therapy.- Disturbances of Cellular Membranes and Membrane-Bound Enzymes in Cryogenic Brain Edema.- Modifications of cAMP and Creatine Kinase-Isoenzymes in CSF in Experimental Head Injury.- b) Cerebral Ischemia.- Cell Swelling Mechanisms in Brain.- Progression and Irreversibility in Brain Ischemia.- The Role of Recirculation for Functional and Metabolic Recovery after Cerebral Ischemia.- Post-Ischemic Pathophysiology in the Gerbil Brain - Changes of Extracellular K+ and Ca++.- Role of Synaptic Transmission Failure in the Neurologic Deficit of Ischemic Brain Injury.- Increased Vulnerability of the Traumatized Brain to Early Ischemia.- Recent Advances in the Study of Cerebrovascular Receptors.- Role of Cerebral Microcirculation in Secondary Brain Damage.- Influence of Experimental Hydrocephalus on Cerebral Vascularization.- III. Clinical Aspects and Treatment.- a) Head Injury.- Avoidable Mortality, Morbidity and Secondary Brain Damage after Recent Head Injury.- Relevance of Primary and Secondary Brain Damage for for Outcome of Head Injury.- Can Secondary Brain Damage be Prevented by Pharmacological or other Means?.- Contusional Hemorrhage - Prognostic Significance of Primary and Secondary Brain Damage.- b) Cerebral Ischemia.- Systematic Search for Brain Resuscitation Potentials after Total Circulatory Arrest.- Non-Steroidal and Non-Barbiturate Treatment of Secondary Brain Damage.- Feasibility of Preventive Brain Protection in Patients at Excessive Risk of Stroke.- Contributors.