Pathophysiological alterations in the central nervous system due to trauma.

Neurotrauma is the largest cause of death and severe disability in young adults. In this review, the pathophysiological processes which damage the brain and spinal cord, both acutely, and hours to days after injury, are discussed. Secondary, delayed damage is the major cause of bad outcome in at least 40% of patients, with severe head injury. Diffuse damage to axons, hypoxic-ischaemic damage to neurons and astrocytes, contusions, intracranial haematomas, and brain swelling are discussed. The prospect for improving outcome by pharmacological therapy, and the current status of head injury trials are presented.