The management of severe acute neurological patients is a constant medical challenge due to its complexity and dynamic evolution. Multimodal brain monitoring is an important tool for clinical decision at bedside. The datasets collected by the several brain monitors help to understand the physiological events of acute lesion and to define patient-specific therapeutic targets. We changed from pure neurological clinical evaluation to an era of structure and image definition associated with instrumental monitoring of pressure, flow, oxygenation, and metabolism. At each time, we want to assure perfect coupling between energy deliver and consumption, in order to ensure adequate cerebral blood flow and metabolism, avoid secondary lesion, and preserve normal tissue.Continuous monitoring of intracranial pressure, cerebral perfusion pressure, and cerebrovascular reactivity with transcranial Doppler, allows us to predict cerebral blood flow. However, adequate blood flow means not only quantity but also quality. To study and avoid tissue hypoxia we start to use methods for evaluation of oxygen extraction, such as oxygen jugular saturation, cerebral transcutaneous oximetry or measurement of oxygen pressure with intraparenchymal probes. To better understand metabolic cascade we use cerebral microdialysis to monitor tissue metabolites such as glucose, lactate/pyruvate, glycerol or cytokines involved in the acute lesion. Multimodal brain monitoring in neurocritical care practice helps neurointensivists to better understand the pathophysiology of acute brain lesion and accomplish the challenge of healing the brain and rescue lives.