Neurochemical monitoring of the acutely injured human brain.

The main goal of modern neurointensive care (NIC) of patients with acute brain injury (traumatic brain injury, neurovascular disease) is to prevent additional loss of viable brain tissue due to secondary injury processes. It is generally held that secondary injury, mediated by, for example, cerebral hypoxia/ischemia and destructive molecular cascades on the cellular level, contributes significantly to the extent of brain damage after head injury and stroke. The basic concept is that improved knowledge of the secondary injury processes will lead to new therapeutic approaches in NIC. New methods by which secondary injury processes can be detected and monitored in NIC patients are therefore greatly needed. This paper describes intracerebral microdialysis as a novel approach to neurochemical monitoring of the human brain. The main objectives are (i) to monitor cortical energy metabolism in order to detect secondary ischemia and (ii) to monitor secondary injury processes, such as glutamate receptor overactivation and increased free radical production, in NIC patients.