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Jai Ganesh

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Registered: 2005-06-28

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Cerebral edema

Cerebral edema

Gist

“Cerebral edema“ is the medical term for brain swelling, or swelling that happens in part or all of your brain because of excessive fluid buildup in the tissue. Your skull protects your brain, but it can't expand to hold extra fluid. “Intracranial pressure“ is the term for pressure inside your skull.

Summary

Cerebral edema is also known as brain swelling. It’s a life-threatening condition that causes fluid to develop in the brain.

This fluid increases the pressure inside of the skull — more commonly referred to as intracranial pressure (ICP). Increased ICP can reduce brain blood flow and decrease the oxygen your brain receives. The brain needs an uninterrupted flow of oxygen to function properly.

Swelling is the body’s response to injury. It can sometimes be treated with medication and rest.

Brain swelling can be very difficult to treat. It can also cause irreversible damage. The swelling can occur throughout the brain or in certain areas. Left untreated, cerebral edema can be fatal.

What are the symptoms?

Cerebral edema can be difficult for doctors to diagnose without proper tests and a thorough evaluation.

There are some symptoms to look for after an injury or infection that could indicate swelling. Some indications of cerebral edema include:

* headache
* dizziness
* nausea
* lack of coordination
* numbness

In more severe cases of cerebral edema, you may experience symptoms including:

* mood changes
* memory loss
* difficulty speaking
* incontinence
* change in consciousness
* seizures
* weakness

What causes cerebral edema?

There are several factors that can cause brain swelling. They include:

* Traumatic brain injury (TBI). A TBI causes damage to the brain. Physical contact and falls can cause the brain to swell. In more severe cases, a TBI can crack the skull and pieces of the skull can rupture blood vessels in the brain and cause swelling.
* Stroke. Some cases of stroke can cause brain swelling, specifically an ischemic stroke. An ischemic stroke occurs when there’s a blood clot near the brain, preventing the brain from receiving blood and oxygen. This can cause brain cells to die and the brain to swell in response to the injury.
* Infection. Some bacteria can cause illnesses and disorders that lead to brain inflammation and swelling, especially if left untreated.
* Tumors. Brain tumors can add pressure to areas of the brain, causing the surrounding brain to swell.

Other causes of brain swelling include:

* high altitude
* unhealthy use of drugs
* viral infections
* carbon monoxide poisoning
* bites from poisonous animals, reptiles, and some marine animals

How is it diagnosed?

Cerebral edema is a difficult condition for doctors to diagnose without proper testing. Your diagnosis will depend on your symptoms and the underlying cause.

Some common procedures doctors use to diagnose brain swelling include:

* physical exam to detect pain, discomfort, or abnormalities
* CT scan to identify the location of the swelling
* head MRI to identify the location of the swelling
* blood tests to determine the cause of brain swelling.

Details

Cerebral edema is excess accumulation of fluid (edema) in the intracellular or extracellular spaces of the brain. This typically causes impaired nerve function, increased pressure within the skull, and can eventually lead to direct compression of brain tissue and blood vessels. 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.

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. Diagnosis is based on symptoms and physical examination findings and confirmed by serial neuroimaging (computed tomography scans and magnetic resonance imaging).

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. Extensive cerebral edema can also be treated surgically with a decompressive craniectomy. Cerebral edema is a major cause of brain damage and contributes significantly to the mortality of ischemic strokes and traumatic brain injuries.

As cerebral edema is present with many common cerebral pathologies, the epidemiology of the disease is not easily defined. 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. For example, malignant brain edema was present in roughly 31% of people with ischemic strokes within 30 days after onset.

Signs and symptoms

The extent and severity of the symptoms of cerebral edema depend on the exact etiology but are generally related to an acute increase of the pressure within the skull. As the skull is a fixed and inelastic space, the accumulation of cerebral edema can displace and compress vital brain tissue, cerebral spinal fluid, and blood vessels, according to the Monro–Kellie doctrine.

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. 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. The Cushing reflex often indicates compression of the brain on brain tissue and blood vessels, leading to decreased blood flow to the brain and eventually death.

Causes

Cerebral edema is frequently encountered in acute brain injuries from a variety of origins, including but not limited to:

* Traumatic brain injury
* Stroke
* Tumors
* Infections (such as a brain abscess or meningitis)
* Hepatic encephalopathy
* Posterior reversible encephalopathy syndrome
* Radiation-induced brain edema
* Post-surgical changes
* Amyloid-related imaging abnormalities associated with edema (ARIA-E)
* Hyponatremia
* High-altitude cerebral edema

Risk factors

Cerebral edema is present with many common cerebral pathologies and risk factors for development of cerebral edema will depend on the cause. The following were reliable predictors for development of early cerebral edema in ischemic strokes.

* Younger age
* Higher severity of symptoms on the National Institutes of Health Stroke Scale
* Signs of current ischemia on clinical exam
* Decreased level of consciousness
* Hyper dense artery sign and larger affected area on CT imaging
* Higher blood glucose

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