Brain Research Reviews 39 (2002) 55–73 www.elsevier.com / locate / bres Review Cerebral ischemia and trauma—different etiologies yet similar mechanisms: neuroprotective opportunities a, b * Ronen R. Leker , Esther Shohami a Department of Neurology and the Agnes Ginges Center for Human Neurogenetics, Hebrew University-Hadassah Medical School and Hadassah University Hospital, Jerusalem, Israel b School of Pharmacology, Hebrew University-Hadassah Medical School and Hadassah University Hospital, Jerusalem, Israel Accepted 6 March 2002 Abstract Cerebral ischemia leads to brain damage caused by pathogenetic mechanisms that are also activated by neurotrauma. These mechanisms include among others excitotoxicity, over production of free radicals, inflammation and apoptosis. Furthermore, cerebral ischemia and trauma both trigger similar auto-protective mechanisms including the production of heat shock proteins, anti-inflammatory cytokines and endogenous antioxidants. Neuroprotective therapy aims at minimizing the activation of toxic pathways and at enhancing the activity of endogenous neuroprotective mechanisms. The similarities in the damage-producing and endogenous auto-protective mechanisms may imply that neuroprotective compounds found to be active against one of these conditions may indeed be also protective in the other. This review summarizes the pathogenetic events of ischemic and traumatic brain injury and reviews the neuroprotective strategies employed thus far in each of these conditions with a special emphasize on their clinical relevance and on future directions in the field of neuronal protection.  2002 Elsevier Science B.V. All rights reserved. Theme: Disorders of the nervous system Topic: Ischemia Keywords: Stroke; Traumatic brain injury; Neuroprotection Contents 1. Introduction ............................................................................................................................................................................................ 56 2. Identifying the tissue at risk...................................................................................................................................................................... 56 3. Pathogenesis of cell damage ..................................................................................................................................................................... 58 3.1. Excitotoxicity ................................................................................................................................................................................. 58 3.2. Nitric oxide .................................................................................................................................................................................... 58 3.3. Reactive oxygen species .................................................................................................................................................................. 60 3.4. Inflammation .................................................................................................................................................................................. 60 3.5. Endothelins ..................................................................................................................................................................................... 60 3.6. Apoptosis ....................................................................................................................................................................................... 60 4. Endogenous protective mechanisms .......................................................................................................................................................... 61 4.1. Heat shock proteins ......................................................................................................................................................................... 61 4.2. Anti-inflammatory cytokines ............................................................................................................................................................ 61 4.3. Growth factors ................................................................................................................................................................................ 61 4.4. Endogenous antioxidant mechanisms ................................................................................................................................................ 62 4.5. Endocannabinoids ........................................................................................................................................................................... 62 *Corresponding author. Department of Neurology, Hadassah University Hospital, P.O. Box 12000, Jerusalem 91120, Israel. Tel.: 1972-2-677-6945; fax: 1972-2-643-7782. E-mail address: leker@cc.huji.ac.il (R.R. Leker). 0165-0173 / 02 / $ – see front matter  2002 Elsevier Science B.V. All rights reserved. PII: S0165-0173(02)00157-1