The position of the head of the patient influences the cerebral venous return and cerebral perfusion pressure (CPP). In our daily practice, it is almost routine to prescribe a Trendelenburg position 30 ° in all brain-damaged patients. However, this is based only on precarious bibliographic databases. It has been shown to decrease the Intracranial Pressure (ICP) in Trendelenburg position relative to the horizontal, with varying effects on PPC. Effects on sylvian objectified by Doppler velocities and cerebral oxygenation seem unaffected by changes of position of the head of the patient. But the whole of the literature on this subject has significant bias.

Registration of blood flow changes induced when the patient's head will be tilted at 0 ° (that is to say flat), 15 ° and 30 ° (the order of actions will be determined by randomization). The patient will remain 10 minutes in each of these positions and will also have a little extra blood sample of 1 ml (ie 9 samples). These measures will be carried out again the next day and then after five days to see if the results vary depending on the evolution of his condition.

Inclusion Criteria:

• Patients aged over 18 years with:

  • A severe head injury
  • or subarachnoid hemorrhage before the 5th day of evolution
  • or spontaneous intracranial hematoma
  • or ischemic stroke

• Neurosurgical Patients after surgery

• Presenting intracranial hypertension

Exclusion Criteria:

• Hemodynamic and / or neurological instability. In the most unstable patients, care and mobilizations are reduced to a minimum.
• Craniectomy

Patient with brain lesion