Cerebral edema

Not to be confused with Hydrocephalus.

Cerebral edema
Other namesBrain edema,[1] Cerebral oedema, [2] Brain swelling
Skull MRI (T2 flair) of a brain metastasis with accompanying edema
SymptomsHeadache, nausea, vomiting, decreased consciousness, seizures
Differential diagnosisischemic stroke, subdural hematoma, epidural hematoma, intracerebral hematoma, intraventricular hemorrhage, subarachnoid hemorrhage, hydrocephalus, traumatic brain injury, brain abscess, brain tumor, hyponatremia, hepatic encephalopathy

Cerebral edema is excess accumulation of fluid (edema) in the intracellular or extracellular spaces of the brain.[1] This typically causes impaired nerve function, increased pressure within the skull, and can eventually lead to direct compression of brain tissue and blood vessels.[1] Symptoms vary based on the location and extent of edema and generally include headaches, nausea, vomiting, seizures, drowsiness, visual disturbances, dizziness, and in severe cases, death.[1]

Cerebral edema is commonly seen in a variety of brain injuries including ischemic stroke, subarachnoid hemorrhage, traumatic brain injury, subdural, epidural, or intracerebral hematoma, hydrocephalus, brain cancer, brain infections, low blood sodium levels, high altitude, and acute liver failure.[1][3][4][5][6] Diagnosis is based on symptoms and physical examination findings and confirmed by serial neuroimaging (computed tomography scans and magnetic resonance imaging).[3]

The treatment of cerebral edema depends on the cause and includes monitoring of the person's airway and intracranial pressure, proper positioning, controlled hyperventilation, medications, fluid management, steroids.[3][7][8] Extensive cerebral edema can also be treated surgically with a decompressive craniectomy.[7] Cerebral edema is a major cause of brain damage and contributes significantly to the mortality of ischemic strokes and traumatic brain injuries.[4][9]

As cerebral edema is present with many common cerebral pathologies, the epidemiology of the disease is not easily defined.[1] The incidence of this disorder should be considered in terms of its potential causes and is present in most cases of traumatic brain injury, central nervous system tumors, brain ischemia, and intracerebral hemorrhage.[1] For example, malignant brain edema was present in roughly 31% of people with ischemic strokes within 30 days after onset.[10]

  1. ^ a b c d e f g Leinonen V, Vanninen R, Rauramaa T (2018), "Raised intracranial pressure and brain edema", Neuropathology, Handbook of Clinical Neurology, vol. 145, Elsevier, pp. 25–37, doi:10.1016/b978-0-12-802395-2.00004-3, ISBN 978-0-12-802395-2, PMID 28987174
  2. ^ 'Oedema' is the standard form defined in the Concise Oxford English Dictionary (2011), with the precision that the spelling in the United States is 'edema'.
  3. ^ a b c Cite error: The named reference pmid176132302 was invoked but never defined (see the help page).
  4. ^ a b Lahner D, Fritsch G (September 2017). "[Pathophysiology of intracranial injuries]". Der Unfallchirurg. 120 (9): 728–733. doi:10.1007/s00113-017-0388-0. ISSN 1433-044X. PMID 28812113. S2CID 7750535.
  5. ^ Wijdicks EF (2016-10-27). "Hepatic Encephalopathy". The New England Journal of Medicine. 375 (17): 1660–1670. doi:10.1056/NEJMra1600561. ISSN 1533-4406. PMID 27783916.
  6. ^ Dehnert C, Bärtsch P (2017). "[Acute Mountain Sickness and High-Altitude Cerebral Edema]". Therapeutische Umschau. 74 (10): 535–541. doi:10.1024/0040-5930/a000954. ISSN 0040-5930. PMID 29690831.
  7. ^ a b Adukauskiene D, Bivainyte A, Radaviciūte E (2007). "[Cerebral edema and its treatment]". Medicina. 43 (2): 170–176. doi:10.3390/medicina43020021. ISSN 1648-9144. PMID 17329953.
  8. ^ Jha RM, Kochanek PM (November 7, 2018). "A Precision Medicine Approach to Cerebral Edema and Intracranial Hypertension after Severe Traumatic Brain Injury: Quo Vadis?". Current Neurology and Neuroscience Reports. 18 (12): 105. doi:10.1007/s11910-018-0912-9. ISSN 1534-6293. PMC 6589108. PMID 30406315.
  9. ^ Thorén M, Azevedo E, Dawson J, Egido JA, Falcou A, Ford GA, Holmin S, Mikulik R, Ollikainen J, Wahlgren N, Ahmed N (September 2017). "Predictors for Cerebral Edema in Acute Ischemic Stroke Treated With Intravenous Thrombolysis" (PDF). Stroke. 48 (9): 2464–2471. doi:10.1161/STROKEAHA.117.018223. ISSN 1524-4628. PMID 28775140.
  10. ^ Wu S, Yuan R, Wang Y, Wei C, Zhang S, Yang X, Wu B, Liu M (December 2018). "Early Prediction of Malignant Brain Edema After Ischemic Stroke". Stroke. 49 (12): 2918–2927. doi:10.1161/STROKEAHA.118.022001. ISSN 1524-4628. PMID 30571414.