Traumatic brain injury (TBI) is a non-degenerative, non-congenital insult to the brain from an external mechanical force, possible lead to permanent or temporary impairment of cognitive, physical, and psychological functions, associated with diminished or altered state of consciousness. severe TBI presented by a headache, vomiting or nausea, convulsions, weakness or numbness in the limbs, loss of coordination, confusion.Signs of increased ICP which is Cushing's triad( wide pulse pressure, bradycardia, irregular respiration) indicates significantly raised ICP.
A hyper-adrenergic state found with severe TBIpresentsas a mild formas SIRS or up to the paroxysmal sympathetic storms (PSS), which is the most severe form of the hyper-adrenergic states (called “brain storms").
Beta blockers have Neuroprotective effects through decreased cerebral blood flow and decreased glucose and oxygen consumption, thus reducing cerebral metabolism.but this potential benefit remains purely speculative and restricted only to B-blockers that can cross blood brain barriers.

AIM OF THE WORK:
The aim of this study was to compare the effect of intravenous metoprolol vs placebo in severe traumatic brain injury patients and how it affected patient heart rate control, mortality, hospital stay, mechanical ventilation (MV) days, ICU stay.