Cerebral Edema

Cerebral Edema – General Information

Cerebral Edema is generally characterized by an increased amount of interstitial fluid. Cerebral Edema can lead to hemorrhages or strokes which are considered medical emergencies. Edema, also known as oedema, or, in some places, as dropsy or hydropsy, is considered to be caused by the increased level of interstitial fluid in any organ that causes swelling. Usually, the level of interstitial fluid is in the balance of homeostasis. An increased production of this fluid into the interstitium or an impaired removal of this fluid can lead to the appearance of edema. There are many types of this kind of disease. They include vasogenic, cytotoxic, osmotic, hydrostatic, interstitial and high altitude edema. The vasogenic type of the disease is caused by the entering of water in the white matter of the patient’s nervous system. This moves extracellulary along fiber tracts, easily affecting the gray matter as well. This type of edema is observed in response to trauma, tumors, focal inflammation, late stages of cerebral ischemia and hypertensive encephalopathy. The cytotoxic type of edema appears because of the derangement in cellular metabolism causing an inadequate functioning of the sodium and potassium pump inside the glial cell membrane. Due to this fact, there is a cellular retention of sodium and water, and can present swollen astrocytes in gray and white matter. The hydrostatic form of edema is encountered in acute, malignant hypertension. The interstitial form of the disease occurs in obstructive hydrocephalus. The high altitude form of the edema, also known as HACE, is a severe, in most of the cases fatal, form of altitude sickness. This type of Cerebral Edema is a result of swelling of the brain tissue from fluid leakage.

Cerebral Edema – Symptoms

The signs and symptoms of the Cerebral Edema differ depending on the form of the disease. General signs and symptoms of the disease can be experienced by all patients affected by all types of the disease and can include a sudden, severe headache which is related to this type of disorder. These symptoms are generally accompanied by stiff neck, facial pain, pain between the eyes, vomiting, and altered consciousness. Other signs and symptoms of Cerebral Edema include those that indicate increased intracranial pressure, provoked by a swelling or collection of blood. These can include increased blood pressure, unequal pupils, particularly when one pupil is dilated and does not react to light, headache, vomiting, visual disturbances, and decorticate or decerebrate posturing. Signs and symptoms characteristic to high altitude form of the edema can include headache, loss of coordination, called ataxia, weakness, and decreasing levels of consciousness such as disorientation, loss of memory, hallucinations, psychotic behavior, and even coma. It usually appears after more than a week at high altitude. Severe cases of this edema can lead to the death of the individual if it is left untreated. Immediate descent is considered a necessary life saving measure. Headache is one of the most common symptoms in patients with Cerebral Edema. The classic headache is characterized as severe, painful in the morning, and appears in combination with nausea or vomiting. Studies have shown that only about twenty per cent of patients with this disease experience this classic headache. Many patients develop headaches that are characterized as tension headaches, which consist in a constant, dully achy feeling on both sides of the head.

Cerebral Edema – Treatment

There are many ways to treat Cerebral Edema and can include osmotherapy, diuretics, hyperventilation, other agents or, in some cases, surgical operation. The most rapid and effective ways of decreasing tissue water and brain bulk is the osmotherapy procedure. Osmotic therapy consists in drawing water out of the brain using an osmotic gradient. Thus also decreases the blood’s viscosity. These changes can further decrease ICP and increase the cerebral blood flow. Mannitol is the most prescribed osmotic agent. Osmotic therapy that employs this osmotic agent reduces ICP by mechanisms that have remained unknown up until now. Mannitol has also the effect of decreasing the brain volume by decreasing overall water content and reducing blood volume by vasoconstriction operation to reduce CSF volume. Mannitol can also improve the cerebral perfusion by decreasing viscosity or altering the red blood cell rheology. Due to this fact, mannitol can exert a protective effect against biochemical injury. This type of osmotic agent is administered in a dosage of 1 g per kg, then 50 g every two to three hours. When mannitol is applied, one has to aim for plasma osmolality 300 to 310 mOsm per L with maintenance of adequate plasma volume. A long term administration of mannitol results in an electrolyte imbalance that can override its benefits and that must be safely monitored. Taking care of the patient who suffers from Cerebral Edema and who receives mannitol requires vigilant monitoring of electrolytes, overall fluid balance and study for the development of any cardiopulmonary complications in combination to neurological assessment. The effects provided by the osmotic agent can be prolonged by the use of diuretics, prescribed as Furosemide, after the osmotic infusion. These kinds of diuretics, including Furosemide, can be administered as an adjunct therapy. Furosemide, taken in 0.7 mg per kg doses, has shown to improve the reversal of the blood brain osmotic gradient established with the mannitol therapy. It achieves his purpose by preferentially excreting water over solute. Corticosteroids have the effect of decreasing the intracranial pressure primarily in vasogenic type of Cerebral Edema because of their beneficial action on the blood vessels. They can be less effective in the cytotoxic type of the disease, and are not recommended by the doctors in treatment of secondary stage, because they can cause a stroke or haemorrhage. Generally, systemic complications of steroids can worsen the individual’s condition. Corticosteroids have not proven to be effective in stroke unless the stroke is provoked by a documented cerebral vasculitis. Dexamethasone is an injection which is administered in 4 to 6 mg doses, intramuscular, every 4 to 6 hours. It is the only way it grants its high beneficial effects. Such medicines have also been applied in chronic meningitis and in acute bacterial meningitis in combination with some antibiotics. A controlled hyperventilation is effective in reducing the raised ICP. The cerebral vasculature is sensitive especially to arterial CO2 changes around the normal level of 40 mm Hg. ICP falls within minutes after the start of hyperventilation procedure and even the buffering mechanisms in the CSF and the extra cellular fluid that restores the pH to a normal level the effect can last for many days. It is very important to monitor the action of ventilation carefully by blood gas analysis and chest radiographic procedures. The surgical removal of lesions responsible for Cerebral Edema results in the resolution of Cerebral Edema. In cases of severe hydrocephalus shunt is considered very effective.

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Cerebral Edema

Cerebral Edema – General Information

Cerebral Edema – Symptoms

Cerebral Edema – Treatment

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