Cerebral insult (insult, weakness, cerebral palsy) is a sudden neurological deficit caused by disturbance of brain blood flow. The term includes both ischemic and hemorrhagic incident. Ischemic cerebral insult happens when a blood clot or embolus blocks or slows down blood flow in the brain artery, thus blocking transport of oxygen and glucose that are necessary for regular function of the brain. It could be also caused by a spasm of brain arteries, without any obstruction of the arterial flow. In the brain tissue that has remained without oxygen necrotic damage or infarction occurs, with consecutive peripheral motoric and sensory defects. Hemorrhagic form is caused by bleeding and is therefore also called cerebral hemorrhage, mainly due to the rupture of brain aneurism or weakened or inflamed brain vessel. Bleeding causes an increase in intracranial pressure that damages tissues and cells. This type of brain insult has a mortality of some 80%.
HBOT lessens brain ischemia and hypoxia, facilitates oxygen delivery to tissues by lower blood viscosity, lowered aggregation of thrombocytes and increased elasticity of erythrocytes, lessens edema of brain tissue affected by infarction, lessens edema of cells ameliorating their metabolism, enhances oxygenation of cells in the zone of ischemic shade (ischemic penumbra; the zone between the zone of infarction and vital tissue containing cells in danger but alive and could be saved), prevents glycolysis and consecutive lactic acidosis and maintains metabolic functions of the jeopardized brain zone.
Brain injury (post-traumatic encephalopathy):
The treatment of brain injuries is focused on the cascade of events that occur after an injury: ischemia and tissue edema, an increase of intracranial pressure, destruction of cells and metabolic and enzymatic disturbances. The efficiency of the treatment is based on the possibility of brain tissue recovery. HBOT, together with other non-surgical options, should be considered as an adjunct to surgical intervention or as a primary option if surgery could not or will not be performed for whatever reason.
HBOT causes vasoconstriction thus diminishing blood flow through the brain and consecutively diminishes edema, whilst enhanced oxygenation suppresses ischemia and consecutive neural tissue damage. Lower blood flow lowers the influence of increased blood pressure. It has been demonstrated that HBOT per se lowers increased intracranial pressure.
Spinal cord injury:
Key goals of application of HBOT in the treatment of spinal cord injury are lessening of edema and correction of ischemia. The development of spinal cord injury includes ischemia of gray matter and increased blood flow in spinal cord with edema of white matter. Consecutively, loss of function and paralysis below the level of injury occur.
If HBOT is applied in the treatment, some neural tissue damage caused by hemorrhage, not by shearing, is reversible. HBOT lessens ischemia in the gray matter, lessens edema in the white matter and corrects biochemical disturbances at the site of spinal cord injury. Rehabilitation is the most important part of the entire therapy of a spinal cord injury patient. HBOT increases capacity for physical exercise in patients with neurologic deficits, lessens metabolic complications of tiredness, increases lung vital capacity and lessens muscular spasticity.