Cerebral Edema

What is Cerebral edema ?

Cerebral edema is the swelling of the brain caused by excessive amount of cerebrospinal fluid in the spaces of the brain. Cerebral edema is a health condition that warrants immediate action.

If medical intervention is not given right away, it could lead to brain damage and even death. Cerebral edema is categorized into various types. They are the following:

Vasogenic cerebral edema

What is vasogenic edema? It is caused by increased permeability of the cerebral capillaries endothelium to plasma proteins such as albumin. It is caused by breakdown of the blood-brain barrier. The proteins and fluids get into the extracellular space leading to swelling of the brain. Conditions leading to vasogenic cerebral edema include head trauma, ischemia, hypertension, and tumor. ^{(1, 2, 3)}

Cytotoxic cerebral edema

What is cytotoxic edema? It is caused by exhaustion of the cell membranes, but without causing any damage to the barrier. The blood brain barrier is intact. However, the abnormal level of potassium and sodium in the membrane would lead to sodium and water retention.

Hydrostatic cerebral edema

It is caused by disturbance of the auto-regulation of the cerebral blood circulation.

Osmotic cerebral edema

It is caused by dilution of blood. It causes abnormal pressure creeping into the brain, which allows water to flow in. it is common in people with hyponatremia and hemodialysis. ^{(3, 4)}

Interstitial cerebral edema

It is caused by acute hydrocephaly (water on the brain). The cerebrospinal fluid brain barrier ruptures.

Diffuse brain edema

What is diffuse brain edema? It is a result of head trauma, anoxia, malignant hypertension, and high altitude. ⁽⁴⁾

Image 1: A radiologic study of patients with cerebral edema.
Picture Source: i.ytimg.com

Picture 2: An image showing the normal structure of the brain.
Photo Source: study.com

Cerebral Edema Causes

• Severe trauma to the head such as after a heavy fall or a car accident.
• Stroke (clotting of blood hinders the oxygen to reach the brain).
• Brain haemorrhage causing increased pressure in the skull. Haemorrhage in the brain can be caused by high blood pressure, injury to the head, malformation of the blood vessel in the brain, or side effects of medications.
• Infection affecting the brain such as encephalitis and meningitis.
• Brain tumor
• Infectious diseases like mumps, malaria, Kawasaki disease, and typhus. ^{(4, 5, 6, 7)}

Signs and Symptoms

What happens if your brain swells? There will be a significant change in the patient’s consciousness level. Other notable signs include the following:

• Nausea
• Confusion
• Numbness
• Lack of coordination
• Dizziness
• Headache
• Vomiting
• Neck stiffness
• Changes in the breathing pattern
• Difficulty walking and talking
• Seizures
• Memory loss
  Stupor – near consciousness or insensibility (5, 7)

Cerebral Edema Diagnosis

If a person is experiencing any of the aforementioned symptoms, the doctor will immediately assess the extent of the symptoms. He will also perform diagnostic procedures and lab works such as CT scan, MRI, and neurologic examination.

The doctor will conduct a thorough examination of the head and neck. Blood works are needed to thoroughly identify the root cause of swelling. (8)

Treatment guidelines

Cerebral edema treatment varies depending on the root cause of the problem. Usually, minor cases of cerebral edema such as the ones caused by slight concussion and altitude sickness resolve in just a few days. Cerebral edema management focuses on ensuring that the brain will receive ample amount of blood and oxygen while the treatment is going on.

Brain swelling after head injury will subside if it receives a combination of medical and surgical intervention. Brain swelling recovery is high if the patient receives the necessary treatment right away. Not receiving prompt treatment could lead to brain damage. The treatment approach includes the following: ^{(7, 8, 9)}

• Oxygen therapy – The patient is put on a respirator or other breathing apparatus to make sure that the blood is receiving enough oxygen. The respirator is adjust into its therapeutic level to make sure that the swelling in the brain subsides.
• Hyperventilation – Controlled Hyperventilation can help in reducing the reducing intra cranial pressure.
• IV fluids – Intravenous fluid along with medications given via IV route will help normalize the blood pressure level. However, the right amount of fluid should be regulated by the doctor to make sure that the brain swelling will not get worst.
• Altering the body’s temperature – Swelling of the brain can be relieved by lowering the body’s temperature. This hypothermic approach to cerebral edema is difficult to perform, but is highly therapeutic when done correctly.
• Medication – The doctor will thoroughly assess the inflammation in the brain. He will prescribe drugs to alleviate the swelling. Some medications help to slow down the body’s response to swelling as well as dissolve clots. To get rid of the excess fluid in the brain, osmotic diuretics are used. An example of osmotic diuretic is mannitol.
• Surgical approach – The purpose of the surgery is to remove a part of the skull so as to relieve intracranial pressure. The surgery will help remove the swelling in the brain and repair any damaged veins and arteries. If the edema is caused by tumor, the growth is removed surgically.

It is important to determine the root cause of cerebral edema. If the root cause is not treated, then there is a high possibility that the problem will happen over and over again. ^{(5, 8, 9, 10)}

Cerebral Edema in DKA

Diabetic ketoacidosis is a serious disease. Cerebral edema is DKA’s life threatening complication. In fact, it is one of the causes of diabetes-related deaths in children. The edema occurs a few hours of treatment with IV fluids and insulin.

Cerebral edema takes place because of the severity of dehydration, acidosis, and hypocapnia (reduced carbon dioxide in the blood) at the presentation of diabetic ketoacidosis. ⁽¹⁰⁾

How to reduce brain swelling naturally?

Positioning

Positioning is important in people with cerebral edema. The head of the patient should be elevated. However, if the patient is suffering from stroke, head elevation is discouraged because a reduced blood flow into the brain could worsen the condition of the patient.

Through proper positioning, excess blood and fluid in the brain will be drained out using the force of the gravity. ⁽⁵⁾

Sleep and relaxation

Make sure you get ample sleep at night. Find some time to relax. Mental and emotional stress should be managed in a healthy way. ⁽⁵⁾

References:

1. www.sciencedirect.com
2. www.livestrong.com
3. www.healthgrades.com
4. https://en.wikipedia.org
5. www.medscape.com
6. www.webmd.com
7. www.ncbi.nlm.nih.gov
8. www.medicalook.com
9. www.epainassist.com
10. Treatment of Cerebral Edema Mario Brock, Alexander Hartmann