There have been some major conceptual changes in the approach to patients with both traumatic and nontraumatic cerebral injury, in recent years. These changes have their basis in a better understanding of the cerebral pathophysi-ology and availability of some recent monitors of cerebral function. Both traditional and modern therapeutic innova-tions are being subjected to extensive investigation. Evidence-based guidelines are now available for the management of traumatic brain injury. Increasing emphasis is being laid on monitoring not only intracranial pressure and cerebral perfusion pressure, but also cerebral blood flow, oxygenation and metabolism. Alternative osmotherapeutic choices are being explored. With a large pool of high quality evidence, more focused and precise therapeutic innovations are likely to emerge in near future.