Cerebral edema

Clinic

• Cerebral edema is excess accumulation of fluid in the intracellular or extracellular spaces of the brain.
• It is an entity, but causes a lot of static disorders due to direct compression of brain tissue and blood vessels include headaches, nausea, vomiting, seizures, drowsiness, visual disturbances, dizziness, coma and death.

Causes

Static	Dynamic
iIschemic stroke Subarachnoid hemorrhage Traumatic brain injury Subdural, epidural, or intracerebral hematoma Hydrocephalus Brain cancer Hyponatremia Acute liver failure	Brain infections High altitude Brain Abscess Meningitis Hepatic encephalopathy Posterior reversible encephalopathy syndrome

Signs / Symptoms

• Increased intracranial pressure (ICP) is a life-threatening surgical emergency marked by symptoms of headache, nausea, vomiting, decreased consciousness. Symptoms are frequently accompanied by visual disturbances such as gaze paresis, reduced vision, and dizziness.
• Cushing reflex:Increased pressures within the skull can cause a compensatory elevation of blood pressure to maintain cerebral blood flow, which, when associated with irregular breathing and a decreased heart rate, is called the Cushing reflex. It often indicates compression of the brain on brain tissue and blood vessels, leading to decreased blood flow to the brain and eventually death.

Classification

• Cytotoxic: It is linked to brain cell death through excessive cellular swelling, including:
  • Traumatic brain injuries, intracerebral hemorrhage, and the early phase of ischemic stroke.
  • Acute liver failure
  • Toxic exposures to Toxin / Drugs
  • Hypoxia

• Vasogenic: It is caused by an increase in blood–brain barrier permeability, including
  • CNS tumors, like glioblastoma and meningioma
  • Meningitis, abscess, and encephalitis
  • Inflammation such as MS
  • Brain hemorrhage
  • Traumatic brain injuries
  • Late stage of ischemic stroke after rapid recovery from cytotoxic edema
  • Hypertensive encephalopathy
  • Radiation injury

• Osmotic: Increased brain Osmolality with intact blood-brain barrier, including
  • Improper administration of intravenous fluids, isotonic or hypotonic.
  • Excessive water intake or inappropriate antidiuretic hormone (SIADH).
  • Rapid reduction of blood glucose
  • Hemodialysis
  • Hyponatremia
  • Brain hemorrhages or infarcts

• Interstitial: Obstruction of cerebrospinal fluid outflow within the ventricular system.

• Hydrostatic: It is caused by severe arterial hypertension.