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Pathophysiological Principles and
Controversies in Neurointensive Care
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Preface:
The last 25 years have seen new advances and approaches with, in some instances, contradictory therapeutic concepts in basic research as well as clinical practice of neurointensive care medicine. In 1960 Nils Lundherg published his paper on ''continuous recording and control of ventricular fluid pressure in neurosurgical practice'' which proved to be of major importance for present day neurointensive care management. To our knowledge no special neurointensive care unit existed at that time in Europe or North America. When my teacher Prof. Hugo Ruf opened his own 22-bed neurosurgical intensive care unit at the new neurosurgical hospital of the J. W. Goethe University of Frankfurt/Main in 1965, this constituted a decisive step forward and was a genuine milestone on the way to modern neurosurgery. While the half-life of validated scientific knowledge becomes ever shorter, its translation into action becomes ever faster.
It was therefore only logical to focus the papers and discussions of the 2nd EMN Congress on ''the pathophysiological principles and controversies in neurointensive care'', especially since the Euroacademia Multidisciplinaria Neurotraumatologica is a scientific association of selected multidisciplinary medical and nonmedical specialists. The EMN deals specifically with the improvement of prevention, acute treatment and rehabilitation in patients with injuries of the central and peripheral nervous system. The idea of treating patients with severe primary head injuries in intensive care under largely physiological conditions in order to prevent often catastrophic secondary damage and tertiary complications was based on the ''Lund conlcept''. This concept, supported by results from animal experiments and long years of clinical observation, led to a unique improvement of late outcome in severely head-injured patients.
The detailed illustration of special clinical aspects by the multidisciplinary scientists invited from various European countries highlighted the value of working sessions in select circies. All clinicians or researchers primarily concerned with the mechanisms of neuronal damage and strategies in neurointensive care and interested in the latest findings in pathophysiology nd outcome in stroke and head-injured atients benefited from this state-of-the-art knowledge, the critical comments on contributions and theses as well as the controversial views.
Being able to publish within just three months has been thanks to the understanding and discipline of the authors as well as the local office secretaries, Gabriele Kühling and Bernd Hoffmann (MD), Münster. However, it was in particular thanks to the personal commitment and circumspect management of printing by Manfred Wester, Munich, and the outstanding personal courtesy of the publisher Werner Zuckschwerdt, who enabled the realization of the book in the accustomed quality. We should like to express our sincerest thanks to all of them.
Klaus R. H. von Wild
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