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Hermes A. Kontos and Enoch P. Wei

E xperimental fluid-percussion brain injury causes cerebral arteriolar abnormalities, manifested by sustained arteriolar dilation, reduced vasoconstrictor responses to arterial hypocapnia, reduced or absent vasodilator responses to arterial hypotension, focal morphological lesions of the endothelium and vascular smooth muscle, and reduced vessel wall oxygen consumption. 25 These abnormalities are inhibited by pretreatment with cyclo-oxygenase inhibitors, or by oxygen radical scavengers. 26 They were therefore ascribed to the generation of oxygen radicals

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Boris Klun

T he enzyme activity in the central nervous system is poorly understood compared to that in some other organs, such as the liver and heart. Enzyme activity has been investigated in inflammatory, 9 vascular, 6, 14 and hereditary 2 diseases and in tumors, 12 while only little is known about the enzymatic processes in brain injuries. 1, 3–5, 10, 11, 13 The purpose of this study was to investigate any correlation between the activity of several brain enzymes and the severity of the injury, and to find a method that would allow quantitative evaluation of

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William F. Bouzarth, J. N. Crowley, and Harris R. Clearfield

V ascular compression of the duodenum, occasionally resulting in symptoms of high intestinal obstruction, has been recorded in patients with weight loss and prolonged recumbency. 1 Patients with severe brain injury are subject to these predisposing factors; however, our review of the recent reports in English as well as the experience of Bockus 3 did not disclose a specific association of the two. This is understandable since severe brain damage masks most symptoms other than vomiting, which may be interpreted as a manifestation of central nervous system

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Enoch P. Wei, Robert G. Lamb, and Hermes A. Kontos

E xperimental fluid-percussion brain injury in cats causes cerebral arteriolar damage characterized by discrete destructive lesions in the endothelium and vascular smooth muscle of these vessels. 10 These morphological lesions are associated with sustained vasodilation, reduced responsiveness to vasoconstrictor influences, and reduced oxygen consumption of the vessel wall. 10 These abnormalities are either minimized or prevented by pretreatment with cyclo-oxygenase inhibitors or with free oxygen radical scavengers, suggesting that the immediate cause of

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Gill E. Sviri, Rune Aaslid, Colleen M. Douville, Anne Moore, and David W. Newell

C erebral autoregulation is a complex intrinsic control mechanism that maintains a constant cerebral blood flow by constantly changing in the cerebral vascular resistance in response to changing arterial BP or CPP. This mechanism was found to be impaired after brain injury; even minor 1 , 3 and impaired AR has been suggested to be associated with variety of cerebrovascular abnormalities found after injury. 10 Impaired AR may increase the vulnerability of the brain to secondary ischemic insult resulting from reduction in the BP or elevated ICP. 3 , 4 , 5

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Timothy Y. Tran, Irie E. Dunne, and John W. German

benefit in patients with TBIs. 3 , 9 , 21 , 38 , 39 In the present study, the rationale and evidence in support of the use of beta blockers in patients with TBI is summarized. We have tried to limit the current discussion to that of the human condition, and invoke animal studies only when necessary to provide additional pertinent information for this literature review. Traumatic Brain Injury and the Catecholamine Surge The evidence for a significant catecholamine surge following TBI is summarized in Table 1 . 7 , 17 , 27 , 49–51 For decades it has been known

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Robert J. Hamm, Larry W. Jenkins, Bruce G. Lyeth, Daphne M. White-Gbadebo, and Ronald L. Hayes

A lthough many factors have been shown to be related to the clinical outcome of adult patients with head injury, age is one of the most reliable and consistent prognostic indicators of mortality and morbidity rates following traumatic brain injury. 2, 12, 15, 16, 17, 20 Research has found that elderly patients with severe head injuries are twice as likely to die as younger patients. 15 It has also been shown that after 12 years of age there is a progressive age-associated increase in mortality rate following head injury. 12 Furthermore, these age

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R. Zupping

excellent opportunity for research on brain metabolism during the course of various brain disorders, information on the CSF acid-base status in patients with acute brain damage is scanty. 8, 10, 11, 33 The main aim of the present work was to study the role of disturbances in brain gas exchange and disorders of the cerebral acidbase balance on the development of brain damage and on the outcome of the diseased state in patients with acute brain injuries. An effort was made to investigate the importance of brain ECF [H + ] to the regulation of brain oxygen availability and

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Pawel G. Ochalski, David O. Okonkwo, Michael J. Bell, and P. David Adelson

the GABA receptors at the time of the first administration of flumazenil (2.5 hours after initial dose of midazolam). Second, although the patient had sustained a moderate head injury, the imaging findings did not show sulcal effacement or any brain edema causing midline shift to indicate the presence of a significantly elevated ICP ( Fig. 1A ). We therefore did not believe that flumazenil treatment posed the risk of secondary brain injury by elevating ICP. Finally, the patient had not been taking benzodiazepines previously, so her risk of acute withdrawal and

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Terry C. Burns, Ahmed J. Awad, Matthew D. Li, and Gerald A. Grant

outcomes have historically focused on survival. However, as outcomes have progressively improved for several malignancies, there has been an increasing need to preserve and improve the quality of life, not just overall survival. As perhaps the most severe and widespread form of iatrogenic brain injury, much remains to be learned about radiation-induced brain injury—the cognitive price of prolonged survival. Excitingly, compelling prospects exist to not only better understand human CNS pathophysiology through this condition, but to provide meaningful regenerative