9 Natural History and Management Options of Traumatic Brain Injury traumatic brain injury (TBI)

Traumatic brain injury (TBI) is a global health care problem that consumes significant clinical and research resources and the medical and surgical management strategies continues to evolve. From a clinical perspective, the development of sophisticated web-based prediction models has provided clinically useful information regarding prognosis, and the development of sophisticated intracranial monitoring techniques has provided a considerable amount of data regarding the developing secondary brain injury. In addition, the results of several recent prospective multicenter randomized controlled trials have provided important information to guide clinical practice.There have been considerable advances in knowledge regarding the basic science of the complex cellular response to trauma, and this has challenged the traditional classification of primary and secondary brain injury. It is also becoming increasingly apparent that TBI is a very heterogeneous disease process with areas of ischemia coexisting with mass lesions, contusions, areas with blood-brain barrier disruption as well as areas where the brain parenchyma is relatively normal. The optimal management for each type of brain injury will not necessarily be the same, and there are significant limitations when attempting to apply blanket therapies across all types of TBI. What remain to be established are either new or improved therapeutic strategies that convert the basic science and clinical information gained into clinical benefit and this is the challenge in the years ahead.