EMN Publications

The book - consisting of 180 pages, 76 figures and 16 tables - is divided in three main chapters: 

1. Mechanisms of neuronal damage
2. Strategies in neurointensive care
3. Outcome of stroke and head injury patients


Distributors: Brockhaus Kommission, Verlagsauslieferung, Kreidlerstr. 9, D-70806 Kornwestheim
Hans Huber Verlag, Längasstr. 76, CH-3000 Bern 9, Maudrich Verlag, Spitalgasse 21 a, A-1097 Wien Scholium International Inc., 14 Vanderventer Ave, Port Washington, 11050 New York

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, Gahriele 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 outsianding personal courtesy of the publisher Werner Zuckschwerdt, who enabled the realization of the book in the accustomed quality. We shouid like to express our sincerest thanks to all of them.

Klaus R. H. von Wild 

Brain Protection in Severe Head Injury: Accident Prevention Rescue Systems and Primary Care

by H. E. Diemath, Sommerauer, K. R. H. von Wild

W. Zuckschwerdt Verlag, München . Bern . Wien . New York

ISBN: 3-88603-585-9

This book - consisting of 161 pages, 84 figures and 33 tables - is a source of information for doctors in hospitals as well as for general practitioners as a multidisciplinary approach to the subject by means of the publisehd lectures held at the 1st Congress of the EMN 1996 in Salzburg/Austria. It contributes to propagate modern and future-oriented findings in the field of neurotraumatology, and, by its multidisciplinary approach, helps to give severely head injured patients the best possible care and even restore their health. 

Prevention of accidents
Problems begin even before accidents happen, so that a number of substantial contributions in the book deal with the prevention of accidents. Thus the latest results from tests in the research laboratories at VOLKSWAGEN and AUDI are presented which show that great improvements in the field of passive accident prevention have been achieved.

Accident rescue
The prognosis for severely head injured patients is often predetermined on the very spot where the accident occurs and is dependent on a) the expert transport and b) the time-span between accident and primary care at the hospital. Therefore ample space has been allotted in this book to these matters including treatment in the intensive care unit in the hospital.

Brain edema
Treatment of brain edema is a very central and - in many respects - still unsolved problem. But in this field very new findings concerning neuropathological changes in the traumatized brain have been made which will allow new methods in therapy. 

New cerebroprotective substances
Very much money has been spent for many decades for research in the field of the origin and growth of tumors, much less for research in neurotraumatology. The situation has changed in recent years (fortunately!) so that substantial progress has been achieved in basic research in neurotraumatology. In the near future the clinical application of a number of cerebroprotective substances can be envisaged which will definitely improve the outcome of even severe head injuries. 

Improvement in the treatment
Thus a second step is initiated: After - as a first step - logistical measures are taken which improve primary care and transport of accident victims, as a second step improvements in the treatment in hospital are introduced. Thus methods of gauging the parenchymal oxygen partial pressure as well as intracerebral microdialysis - which are already available - will, when once they have become internationational standard, definitely improve the results of treatment. 

Psychological measures
And finally one must not neglect psychological measures of therapy which - side by side with improvements in the field of intensive care - ought to be applied from the intensive care unit onward to rehabilitation and from which the head injured patients as well as their relatives will profit. 

The Editors

Hofrath o. Univ.-Prof. Dr. H. E. Diemath: Neurochirurgische Abteilung, Landesnervenklinik Salzburg, Ignaz-Harrer-Strasse 79, A-5020 Salzburg/Austria

Oberarzt Dr. J. Sommerauer: Neurochirurgische Abteilung, Landesnervenklinik Salzburg, Ignaz-Harrer-Strasse 79, A-5020 Salzburg/Austria

Univ. Prof. Dr. K. R. H. von Wild: Clemenshospital, Akademisches Lehrkrankenhaus, Neurochirurgische Klinik, Düesbergweg 124, D-48153 Münster/Germany