Pharmacological and Adjunctive Therapies in Neuroburn Care

In this chapter, the detailed pathophysiology and management of traumatic brain injury (TBI) are discussed, focusing on the intricate balance between the primary and secondary injury mechanisms. Primary injury involves the neural tissue’s immediate mechanical damage, whereas secondary injury develops over the course of hours to days and is driven by neuroinflammation, oxidative processes, excitotoxic damage, and the breakdown of the blood–brain barrier. This chapter analyzes the mechanisms and processes that occur after TBI on a cellular and molecular level, including cellular respiration and mitochondrial failure, ionic gradients and imbalance, microglial and astrocytic activation, as well as neurodegenerative and progressive neuronal damage processes. In addition, the chapter analyzes the entire scope of TBI, including mild concussions and more severe injuries, focusing on imaging diagnosis as well as biomarker and subclassification systems. Also addressed are the most current strategies in the treatment of TBI, including those in the acute, rehabilitation, and neurocritical care stages, as well as those that are more focused on neuroprotection. Focus is given to the more novel and emerging therapeutic targets, including but not limited to the following: some anti-inflammatory therapies, some antioxidant therapies, and some approaches in regenerative medicine. The final focus of the chapter is that the recovery processes and the long-term understanding of cognitive and functional impairments in TBI patients are best addressed and managed with a multidisciplinary approach.