Preventing and treating cerebral ischaemia is the most important goal in the acute management of head-trauma patients. Prevention of cerebral ischaemia may be achieved through carrying out initial assessment and resuscitation according to life support principles at the site of the accident. Current treatment is based on a pathophysiological approach aiming to ensure adequate cerebral oxygen delivery. Recent research into biochemical disorders such as acidosis, lipid peroxidation, and toxicity of neurotransmitters has resulted in new perspectives on therapy.