The disturbances of cerebral microcirculation in severe head injury

The aim of the literature review was to present modern views on the possible mechanisms of the disturbances of capillary blood flow in severe brain injury (TBI). The critical analysis of the concept of secondary brain damage and possible mechanisms of the disturbances of cerebral microcirculation in TBI are presented. We also discuss modern methodologies for assessing capillary blood flow in patients with brain damage. The attention is focused on the causes of the disturbances of cerebral microcirculation in TBI, as well as in various forms of fat embolism in severe combined TBI. Possibilities of prevention and early correction of damaged capillary blood flow in brain injury, as well as the supposed reasons for the failure of some clinical trials, including the widely known CRASH, are analyzed. It is noted that an integrative approach to the assessment of cerebral microcirculation in conjunction with brain metabolism reflects not just the variability of cerebral blood flow and functional disorders of perfusion and metabolism coupling in traumatic brain injury. It is emphasized that ischemia is not the only cause of post-traumatic disorders of pial circulation. We highlight directions for future research of posttraumatic disturbances of cerebral microcirculation as a leading factor of secondary brain insults. The possibility of pharmacological and non-pharmacological correction of microcirculatory disorders in TBI is outlined.