Can the outcome from head injury be improved?

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Abstract
A classification that includes both the type and the seriousness of head injuries in humans is presented. There appear to be 2 principal causes of the brain damage produced by head injury: mechanical damage to neurons and their processes, especially axons, and ischemia. Mechanical damage produces axonal degeneration. Although central regeneration generally is quite limited, perhaps many of the axons damaged by head injury degenerate in continuity, a circumstance in which functional regeneration by axoplasmic outgrowth is much more likely to occur than in most experimental situations where the axons are physically divided. Ischemic brain damage that is so common in head injury appears to be due to mass lesions and brain swelling, both causing intracranial hypertension. The more the brain swells, and the higher the intracranial pressure, the more difficult it is to control the swelling and the pressure. In patients with acute subdural hematoma in particular, the brain swelling and the high mortality appear to be due to ischemic brain damage. The mortality rate in patients with acute subdural hematoma is probably a function of the time from injury to evacuation of the hematoma. Outcome from head injury can be improved by the earliest possible removal of space-occupying hematomas and by early, vigorous management of intracranial hypertension.