[Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: prevention, diagnostics and therapy]

[Multimodal monitoring in neurointensive care medicine: state of the art]

The prognosis of neurointensive care patients depends largely on the occurrence of secondary ischemic/hypoxic tissue damage, which is mediated by different pathomechanisms, such as edema formation or increased intracranial pressure. Due to the cerebral damage and need for sedation as well as intubation, clinical assessment of these patients is limited. Furthermore, clinical signs of secondary damage, such as advanced herniation syndromes are often delayed and therefore mostly indicate irreversible brain damage. To adequately predict and detect secondary neuronal damage, various neuromonitoring techniques have been developed in recent years with ongoing technical refinement. These can be used for bedside and ideally continuous monitoring of various functional systems of the brain. Neuromonitoring is used to implement early therapeutic measures before irreversible brain damage has occurred, to monitor therapeutic effects, for evaluation of the prognosis and to improve the neurological outcome of patients. Different monitoring techniques are often combined in multimodal neuromonitoring. This article gives an overview of the most promising neuromonitoring techniques available.