Current Progress in the Understanding of Secondary Brain Damage From Trauma and Ischemia : Proceedings of the 6th International Symposium: Mechanisms of Secondary Brain Damage-Novel Developments, Mauls/Sterzing, Italy, February 1998

Information is provided from the basic and clinical sciences on the mechanisms damaging the brain from trauma or ischemia. New aspects involve the endoplasmic reticulum, mitochondrial failure, pathobiology of axonal injury, molecular signals activating glial elements, or the emerging therapeutical role of neurotrophins. Experimental issues involve a better analysis of the ischemic penumbra, the salvagable tissue. Therapeutic contributions reach from the environmental influence to gene expression, including neuroprotection, such as hibernation – mother nature’s experiment – or hypothermia which is reported to induce cell swelling. Treatment issues deal also with thrombolysis and combination therapies, or with the clearance of adverse blood components – LDL/fibrinogen – by a novel procedure using heparin. Other highlights are discussing the specificities of pediatric vs. adult brain trauma, or the evolving role of the Apolipoprotein-E e4 gene in severe head injury. An update is also provided on an online assessment of the patient management during the pre- and early hospital phase in Southern Bavaria. The empirical observation of neuroworsening is analyzed in further details, whether this is a specificity autonomously driving the posttraumatic course. Finally, the unsolved question why drug trials in severe head injury have failed so far in view of the promising evidence from the laboratory is subjected to an expert analysis. Front Matter....Pages I-VIII Disturbance of Endoplasmic Reticulum Functions: A Key Mechanism Underlying Cell Damage?....Pages 1-5 Role and Mechanisms of Secondary Mitochondrial Failure....Pages 7-13 Initiating Mechanisms Involved in the Pathobiology of Traumatically Induced Axonal Injury and Interventions Targeted at Blunting Their Progression....Pages 15-20 Molecular Signals for Glial Activation: Pro- and Anti-Inflammatory Cytokines in the Injured Brain....Pages 21-30 Mechanical and Excitotoxic Lesion of Motoneurons: Effects of Neurotrophins and Ciliary Neurotrophic Factor on Survival and Regeneration....Pages 31-39 Modelling of the Ischemic Penumbra....Pages 41-44 The Acute Ischemic Penumbra: Topography, Life Span, and Therapeutic Response....Pages 45-50 Environmental Influence on Gene Expression and Recovery from Cerebral Ischemia....Pages 51-55 Neuroprotective Strategies in Nature — Novel Clues for the Treatment of Stroke and Trauma....Pages 57-61 Glial Cell Swelling — Effect of Hypothermia....Pages 63-66 The Clot Thickens — Thrombolysis and Combination Therapies....Pages 67-71 Assessment of Brain Tissue Viability Under Clinical Circumstances....Pages 73-80 Heparin-Mediated Extracorporeal LDL/Fibrinogen Precipitation —H.E.L.P.-In Coronary and Cerebral Ischemia....Pages 81-84 Pediatric Head Injury: What is Unique and Different....Pages 85-88 Apolipoprotein E and the Response of the Brain to Injury....Pages 89-92 System Analysis of Patient Management During the Pre- and Early Clinical Phase in Severe Head Injury....Pages 93-97 The Frequency, Antecedent Events, and Causal Relationships of Neurologic Worsening Following Severe Head Injury....Pages 99-102 Neuroprotective Effects of Riluzole in Neurotrauma Models: A Review....Pages 103-110 Challenges in Translating the Efficacy of Neuroprotective Agents in Experimental Models Into Knowledge of Clinical Benefits in Head Injured Patients....Pages 111-116 Back Matter....Pages 117-120