Clinical neuroprotection and secondary neuronal injury mechanisms

Acute brain injury triggers the ischaemic cascade, a series of biochemical events at the cellular level, which leads to a loss of integrity and function of the neurons, consequently decreasing the chance of functional recovery. Neuroprotection refers to therapies capable of mitigating the detrimental effects of secondary brain injury by antagonizing and reversing the pathophysiological mechanism at multiple points, which would otherwise lead to irreversible brain injury. Though several experimental pharmaceutical trials have been conducted with drugs acting at several focal points in the ischaemic cascade, the results have been discouraging. Despite this, in the last few decades, the implementation of guidelines focusing on bedside practice of neuroprotective strategies saw substantial improvement in the outcomes of patients with acute cerebral injury. This article delves into these strategies focusing on their mechanism of action, evidence-based practice and guidelines, and also summarizes the novel therapies currently being evaluated.