Nervous and brain cells injury is a complex, life-threatening condition that causes mortality and disability worldwide. No
effective treatment has been clinically verified to date. Achieving effective drug delivery across the blood–brain barrier (BBB) presents a major challenge to therapeutic drug development for nervous and brain cells injury. Furthermore, the field of nerve damage biomarkers is rapidly developing to cope with the many aspects of pathology and enhance clinical management of this type of damage. Exosomes appear to be effective inter-cellular communicators delivering several types of molecules, such as proteins and RNAs, suggesting that they could influence types of stem cells differentiation. Exosomes are endogenous extracellular vehicles (EVs) containing various biological materials, including lipids, proteins, microRNAs, and other nucleic acids. Compelling evidence exists that Exos, such as stem cell-derived Exos and even neuron or glial cell-derived Exos, are promising treatment strategies for Nervous cells injury because they pass through the BBB and have the potential to deliver molecules to target lesions. Meanwhile, Exos have Fewer safety risks compared to intravenous injection or orthotopic transplantation of viable cells, such as microvascular occlusion or imbalanced growth of transplanted cells. These unique characteristics also make Exos contents, especially Exos-derived microRNAs, as appealing biomarkers in nervous and brain cells injury. In this review, we explore the potential impact of cell-derived Exos and exosome-derived contents on the diagnosis, therapy, and prognosis prediction of nerve damage. The associated challenges and opportunities are also discussed.