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Significant progress has doubtlessly been made in the field of cere bral protection compared to earlier centuries, as recently reviewed by Elisabeth Frost (6). She cites the recommendations for treat ment of brain trauma by Areteus, a Greek physician of the second century A. D. He expressed quite modem views with regard to the need for prompt action considering complications that follow even minor symptoms. He advised burr holes for evacuation of hema toma in seizures, the use of diuretics and, most interestingly, also hypothermia. German surgeons of the 17th century had little more to offer than prescriptions of which the most effective constituent was alcohol (10). Thus, Sir Astley Cooper was probably the next surgeon to make noteworthy contributions when advising the use of leeches to the temporal artery and other means of bleeding in stead of surgical intervention in cases of raised intracranial pressure (loc. cit. 6). Although our knowledge has greatly expanded during the last two decades, extensive discussions have led to only few conclusions. Promising results from animal studies were translated to clinical sit uations only to yield controversial and sometimes confusing results. Since the observations of Brierly (5) on ischemic cell damage, im proved information on structural aspects, probably even related to concomitant biochemical studies, should allow the validity of thera peutic concepts to be verified. Investigations on cerebral ischemia have led to the differentiation of synaptic transmission failure and membrane failure.
List of contents
Structural Aspects of Energy Failure States in the Brain.- Morphological Aspects of Brain Protection in Experimentally Induced Hypoxia.- Survival of Cortical Neurons After Ischemia: Dependency on Severity and Duration.- Membrane Stabilization and Protection of the Ischemic Brain.- Recovery From Disturbed Cerebral Ion Homeostasis Following Severe Incomplete Ischemia and Modification by the Metabolic Depressant Drug Etomidate.- Comparative Evaluation of Barbiturate and CA++Antagonist Attenuation of Brain Free Fatty Acid Liberation During Global Brain Ischemia.- Alterations in Whole Brain Cyclic-AMP and Cerebral Cortex Na-Inducible Cyclic-AMP in Rats During and After Complete Global Ischemia.- Pathophysiology and Pathobiochemistry of Acute Brain Infarction in the Gerbil: The Influence of Metabolic Inhibition.- A Dog Model to Evaluate Post-Cardiac Arrest Neurological Outcome.- Cortical Glucose and Energy Metabolism During Complete Cerebral Ischemia and After Recovery.- Monitoring of Cerebral Ischaemia in Man.- Clinical Trials of Brain Protection: Problems and Solutions.- Pharmacological Effects in Protective and Resuscitative Models of Brain Hypoxia.- The Clinical Use of Hypnotic Drugs in Head Injury.- Indications for Cerebral Protection.- Prophylaxis of Cerebral Ischemic Damage From Vasospasm After Subarachnoid Hemorrhage.- Brain Protection by Barbiturate After Head Injury? Clinical and Experimental Results.- Thiopentone in the Treatment of Severe Head Injury: Is Raised Intracranial Pressure the Sole Indication for Its Use?.- Brain Resuscitation in Children: Current Indications and Future Directions.- Statement and Conclusions.
