Head injury is one of the major causes of death and disability at all ages (Jennett and Teasdale, 1981). Considerable success has been achieved with its prevention and management. Legislation for seat belts, air bags, crash helmets, drink driving, gun control and safer playgrounds have reduced significantly its incidence. Rigorous application of management guidelines for the resuscitation and early management of the head-injured patient, starting at the roadside, has resulted in a significant reduction in mortality and morbidity (Becker et al., 1977; www.nice.org.uk). The advanced trauma and life support (ATLS) and recently published British National Institute of Clinical Excellence (NICE) guidelines seek to prevent and treat such avoidable secondary insults as hypoxia, hypotension, fits and raised intracranial pressure (ICP) due to intracranial hematomas, contusions and brain swelling. Following resuscitation, early computed tomography (CT) will identify intracranial masses, unilateral hydrocephalus due to brain shift and diffuse swelling but is very insensitive at detecting diffuse axonal injury (Gean, 1994). Following appropriate surgery to remove any hematoma, the patient should be admitted to a Neuroscience or Intensive Care Unit. Prognosis for head-injured patients admitted to a Specialist Neuroscience Intensive Care Unit is significantly better than if admitted to a General Intensive Care Unit. Both systemic (blood pressure, arterial blood gases, etc.) and intracranial parameters (ICP and brain oxygen tension) are continuously monitored. Where ICP rises, the CT is repeated to exclude any new or progressive lesions. Algorithms have now been developed to guide intensive care management (Figure 36.1).