home Audience 4 Cerebral edema: causes of secondary pathology. Cerebral edema: causes and consequences of its development How to diagnose cerebral edema

Cerebral edema: causes of secondary pathology. Cerebral edema: causes and consequences of its development How to diagnose cerebral edema

The brain is responsible for the functioning of all organs and systems, so disruption of its functioning invariably causes serious problems in the body. Cerebral edema is the human body's response to infection or overuse. This condition develops in a short time and can disappear just as quickly if the necessary measures are taken in time. If the cause of this condition lies in a traumatic injury or serious illness, then getting rid of it is much more difficult.

The essence of the disease

This pathology is nothing more than the body’s reaction to damaging factors. This could be due to an infectious disease, traumatic injury, or overuse.

During the development of edema, the cells and intercellular space of the brain are rapidly filled with a large amount of fluid. This causes an increase in brain volume, which invariably leads to an increase in intracranial pressure.

As a result, blood circulation deteriorates and brain cells die. This pathology often occurs in children.

In children, factors such as:

traumatic brain injuries;

Newborn children may suffer from this pathology due to hypoxia, maternal diseases, toxicosis during pregnancy, and injuries during childbirth.

Types and classification

Depending on the origin, four main types of edema can be distinguished:

Vasogenic edema. This pathology involves a breakdown of the blood-brain barrier, which causes the penetration of plasma proteins. It is often observed with brain tumors.
Cytotoxic edema. Its development is caused by disturbances in osmoregulation of cell membranes. Their permeability causes excessive swelling of the white matter. This type of cerebral edema is usually observed with skull injuries.
Ischemic edema. It assumes the action of the listed mechanisms, but they progress in stages. An example would be a cerebral hemorrhage. This swelling most often occurs during or after a stroke.
Interstitial edema. In this situation, the brain tissue becomes saturated with excessive amounts of cerebrospinal fluid. This condition is characteristic of hydrocephalus.

Depending on the factor in the development of edema, the following types of pathology can be distinguished:

postoperative (usually such swelling occurs as a consequence of complications after surgery);
post-traumatic (occurs after injury and is characterized by swelling of the brain);
toxic (this type of cerebral edema can develop, for example, due to alcoholism or poisoning with toxic substances);
tumor (it is not uncommon for the patient to die from this type of edema, because it affects large areas of the brain);
inflammatory (occurs after an inflammatory process);
epileptic (swelling due to epilepsy);
ischemic (usually develops after a stroke or hemorrhage);
hypertensive;
neuroendocrine.

If we talk about the size of brain damage, then swelling can be:

Local – located in the area of the lesion.
Diffuse - localized in one hemisphere.
Generalized – observed in two hemispheres.

The location of the edema determines the following types of pathology:

Brainstem swelling. An extremely dangerous condition that is associated with a disorder of vital functions - breathing, blood circulation, etc.
Edema of cerebral vessels.
Swelling of the brain substance.

Edema that develops as a result of hypoxia, tumors, and inflammation must be differentiated from perifocal edema - it is swelling of the brain in the area of cell destruction. This pathology develops with traumatic injuries.

In accordance with ICD-10, this disease is coded under the code G00-G99 “Diseases of the nervous system”, G90-G99 “Other disorders of the nervous system”, G93.6 “Cerebral edema”.

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Causes of cerebral edema

The development of edema can be caused by illness, infection, traumatic injury, and sometimes even a change in altitude. The most common causes of this pathology are:

Traumatic brain damage. This is mechanical damage to the structure of the skull. It is often complicated due to the fact that the brain is injured by bone fragments. Severe swelling prevents fluid from leaking out of the brain tissue.
. A common pathology associated with abnormalities of cerebral circulation. Brain cells do not receive enough oxygen, and therefore they begin to die, which leads to the development of edema.
Hemorrhagic stroke. Associated with damage to cerebral blood vessels. Hemorrhage causes an increase in intracranial pressure.
Infections:
- subdural abscess;

- toxoplasmosis.
Tumors. During the development of such a formation, compression of an area of the brain occurs, which leads to poor circulation and swelling.
Height difference. There is information according to which an altitude of one and a half kilometers above sea level can cause cerebral edema.

Symptoms and signs

Symptoms increase as intracranial pressure increases.

If the swelling progresses, brain structures may shift and become wedged into the foramen magnum.

Sometimes focal symptoms are observed: paralysis and paresis of the oculomotor nerve, as a result of which dilated pupils are diagnosed.

In the early stages, you may notice the following signs:

, which often have a bursting character.
Loss of orientation in time and space.
Sense of anxiety.
Nausea and vomiting with high-intensity headaches.
Stun.
Drowsiness.
Constriction of the pupils.
Breathing problems.
Increased pressure.
Arrhythmia.

In some cases, vision completely disappears - this occurs if there is compression of the posterior artery of the brain.

Also, as the pathology progresses, coordination of movements is impaired, swallowing disorder occurs, severe vomiting, neck stiffness, cyanosis are observed, and tendon reflexes fade.

Sometimes a person loses consciousness and convulsions may occur. In the most difficult situations, a person falls into a coma.

Diagnostics

CT photo of cerebral edema

To make a correct diagnosis, a set of procedures should be performed:

Analysis of anamnesis. The doctor clarifies complaints and analyzes the reasons that could cause this condition.
Neurological examination. At this stage, the level of consciousness and symptoms that indicate neurological disorders are assessed.
Fundus examination. This condition is characterized by swelling of the optic nerve.
Lumbar puncture. A puncture is performed in the lumbar region to determine the increase in intracranial pressure.
Computer and. With these procedures, signs of edema can be assessed.
Measuring intracranial pressure. For this purpose, a special sensor is inserted into the cavity of the ventricles of the brain.

First aid

If cerebral edema is observed, the patient must be given first aid.

It includes the following activities:

Local hypothermia. To do this, the person's head should be covered with ice packs.
Intravenous administration of 20-40 ml of glucose (40%).
Administration of glucocorticoids - dexamethasone (6-8 ml), prednisolone (30-60 mg).
Administration of Lasix in saline solution – 20-40 ml.
Oxygen inhalation.
Administration of piracetam solution intravenously – 10-20 ml.

After first aid is provided, the person is placed in a neurological hospital. If there has been a skull injury, he is admitted to the neurosurgical department.

In case of toxic cerebral edema, especially in the case of coma, the person is hospitalized in the toxicology department or intensive care unit.

It is not possible to relieve cerebral edema on your own, so you must seek medical help.

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Treatment of cerebral edema

There are situations when all signs of illness disappear on their own - this applies to some forms of mountain sickness or mild concussion.

Other cases require immediate medical attention. Only a specialist can decide how to treat cerebral edema, taking into account all the features of the pathology.

Therapy should be aimed at restoring oxygen metabolism in brain cells. This can be achieved through a combination of drug and surgical treatment methods. Thanks to such measures, it is possible to relieve cerebral edema and avoid dangerous health consequences:

Oxygen therapy. This procedure involves introducing oxygen into the airways. This is done through the use of an inhaler or other equipment. Thanks to this, the nutrition of the brain improves, which reduces recovery time.
Hypothermia. Involves a decrease in body temperature. Despite the fact that this method perfectly corrects cerebral edema, today it is not used very often.
Intravenous infusion. With this procedure, it is possible to maintain normal blood pressure, blood flow and fight infections.
Ventriculostomy. Helps reduce intracranial pressure. It involves draining excess fluid through a special catheter.
The choice of medications is made depending on the cause that caused the development of edema.

In particularly difficult cases, surgical intervention is prescribed. During decompensated craniectomy, it is possible to remove part of the skull bone, which reduces intracranial pressure.

Also, during the operation, the cause that caused this pathology can be eliminated. If necessary, the tumor is removed or the damaged blood vessel is restored.

Folk remedies can also help with swelling, but they can only be used after consulting a doctor:

White mistletoe decoction. It is used for the development of formation in the brain. To prepare it you need to take 200 grams of milk and 3 grams of dried mistletoe flowers. The dose must be selected by the doctor.
Propolis tincture. For 1 gram of propolis you need to take 10 grams of alcohol. Pour alcohol into the propolis and leave until completely dissolved, then strain. Take a teaspoon before meals. This should be done three times a day.

Consequences and prognosis

The consequences of the development of this pathology depend on the severity of brain damage.

Conditions such as:

Depression.
Absent-mindedness.
Impaired physical activity.
Constant headaches.
Impaired communication abilities.

The course and consequences of the disease are largely influenced by the adequacy and timeliness of treatment. During edema, pressure is observed on brain structures, which can lead to disruption of the heart and respiratory organs.

Lack of oxygen causes brain cell death. As a result, paralysis of the body may occur. In especially severe cases, the person falls into a coma. If vital parts of the brain are affected, then death occurs.

Cerebral edema is a dangerous disorder that, if not properly treated, can cause serious health consequences. Therefore, it is very important to immediately seek help from a doctor - thanks to this you can save not only your health, but also your life.

Cerebral edema (CE) is a dangerous complication that progresses due to the development of certain cranial diseases. This abnormal process is characterized by an immense accumulation of intracellular fluid in brain cells. That is, decompensated microcirculatory disorders of the internal structures of the organ occur.

When there are actively developing focal pathological lesions in the brain, which are extremely difficult to treat, the function of self-regulation of vascular tone begins to work incorrectly, which causes rapid dilation of blood vessels. Diffuse swelling of cerebral vessels instantly spreads to healthy areas and initiates an increase in pressure in them.

These pathological modifications end in the fact that the vascular walls lose their usefulness and are unable to retain the watery components of the blood, which, under the influence of high pressure, leak through them into the brain tissue. The internal structures of the brain are gradually saturated with blood fluid, and each cell of the organ increases several times.

Since the brain space is limited by the intracranial cavity, such deformations cause metabolic dysfunction, as well as complete/fragmentary disruption of the functioning of the brain.

The patient experiences a disorder of consciousness, and overall health deteriorates sharply. If you do not provide the patient with prompt and adequate medical care, the GM will completely cease to function, which in turn can lead to death.

Cerebral edema - classification

Depending on the etiology of the pathological course, there are four main types of cervical edema:

Vasogenic cerebral edema

Usually develops as a result of traumatic brain injuries, encephalitis, with incorrect blood microcirculation, various formations (cancerous/benign) in the structure of the organ, hemorrhagic strokes, etc. It is characterized by high capillary permeability and BBB dysfunction, due to which vascular fluid penetrates beyond the boundaries of the walls and fills the white matter.

Cytotoxic

Formed during head injury, hypoxia and ischemia of the brain. Cytotoxic edema develops rapidly and is localized in the gray matter of the brain. This type is characterized by swelling of neurons, glia and endothelial cells. The activity of the cell membrane is disrupted, sodium accumulates in large quantities in the brain cells and, under the influence of osmotic pressure, water penetrates into the internal space of the cellular structures.

Interstitial

Occurs with hydrocephalus, otherwise this disease is called “dropsy”. The normal outflow of cerebrospinal fluid in the ventricles is disrupted, and therefore their activity increases and internal pressure increases. Under the influence of the latter, excessive filtration occurs, accumulation of fluid and low molecular weight substances in the brain.

Osmotic

Abnormal changes affect the osmotic vector between the osmolarity of blood plasma and the osmolarity of brain tissue. Osmotic edema of the brain is especially pronounced in patients with acute organ damage and patients with renal failure.

Causes of cerebral edema

The key factors that act as sources of the painful condition include:

TBI – mechanical damage to the bone and tissue structures of the brain leads to the formation of intracranial hematomas, swelling, which prevents the release of accumulated fluid outside the brain tissue.
Ischemic stroke - occurs when cerebral circulation is impaired. Almost no oxygen enters the organ cells, and they gradually begin to die.
Hemorrhagic stroke.
Infections – mumps, influenza, measles, encephalitis, meningitis, etc.
Malignant tumors.
Changes in altitude - scientists have found that at an altitude of 1.5 kilometers above sea level, swelling of the brain can develop (this means a rapid increase in altitude without the body getting used to it).
Intoxications of an endogenous nature, formed as a result of severe diabetes mellitus, liver dysfunction, acute renal failure.
Poisoning with drugs/poisons.
Alcoholism.
Allergies – Quincke's edema, anaphylactic shock.
In infants, the cause of cervical edema can be severe toxicosis in a pregnant woman during gestation, hypoxia, or skull injuries received during childbirth.
Brain swelling after stroke

GM swelling after stroke

This is an almost inevitable phenomenon. Most often, pathology occurs in the presence of tumors in the brain. Characterized by the accumulation of fluid in nerve cells. The following signs may indicate the formation of swelling of the brain after a stroke:

sharp pain in the head;
causeless vomiting;
dysfunction of the visual apparatus or partial loss of functions of other senses;
disorientation in space;
rapid breathing, palpitations, shortness of breath;
stupors;
cramps in the limbs;
fragmented memory loss;
dizziness;
periodic loss of consciousness.

The last symptom is extremely dangerous with swelling of the brain, as it can provoke coma.

Swelling of the GM after surgery

Occurs as a consequence of postoperative complications. Usually appears within 24 to 72 hours after surgery on the organ. Rapid development, failure of preventive measures after surgery and diagnostic problems can provoke coma.

In order to prevent the formation of edema, the patient must be given corticosteroids and fluid drainage in the first three days.

Alcoholic cerebral edema

Long-term consumption of alcohol-containing drinks over time leads to the destruction of brain cells and the formation of edema. In addition to the symptoms characteristic of the disease, the patient’s physique is noticeably different (large belly, thin arms/legs), and he periodically sees visual hallucinations. There is persistent swelling on the face, the skin peels and has a pronounced bluish tint.

GM swelling due to allergies

Allergic swelling of the brain can be caused by various factors (taking certain medications, eating highly allergenic foods, insect bites, etc.). With this type of pathology, the patient’s condition instantly (within several hours) worsens, and phenomena such as:

headache;
fear of light and sound;
numbness of the occipital region (with this condition it is impossible to press the chin to the chest);
vision and speech deteriorate;
nausea, in rare cases vomiting is possible;
numbness of arms and legs;
paralysis.

Symptoms

Symptoms of the pathological process increase gradually as intracranial pressure increases. Common signs of cervical edema in adults include:

sharp pain in the head that cannot be relieved even with the help of strong antispasmodics;
constant feeling of nausea;
vomiting (does not depend on meals and does not bring even short-term relief);
partial/complete loss of hearing and vision, a feeling of constriction in the eyeballs;
shortness of breath;
arrhythmia;
the patient is poorly oriented in time and space, looks lost, is vaguely aware of real events;
seizures;
speech disorder;
neurology – sleep disturbance, sensitivity, muscle tone, fainting, lack of appetite, tremors, etc.;
visual hallucinations;
cerebral palsy, paresis;
loss of consciousness – as edema progresses, the frequency and duration of attacks increases; in severe cases, a person may fall into a coma.

If a patient exhibits signs of cerebral edema and his condition worsens every day, immediate correction of metabolic disorders is required.

Diagnosis of pathology

An experienced neurologist can detect swelling of the brain at the stage of interviewing the patient or his relatives. To assess the extent of the lesion, the specialist will additionally prescribe an MRI and CT scan of the brain and bone marrow. To establish the actual cause of the formation of a pathological condition, the following is carried out:

blood chemistry;
lumbar puncture (sampling is carried out extremely rarely, as this may cause
additional harm to the patient’s health);
other neuroimaging studies at the discretion of the physician.

Treatment

Correct treatment of cerebral edema can be carried out only after identifying the source of the pathology. The main therapy is aimed at eliminating organ dehydration. Certain medical procedures are also performed to relieve the root cause and associated manifestations.

If conservative treatment methods do not produce positive results, then doctors decide on the advisability of surgical intervention (removal of the source of swelling) and trephination of the organ.

Mountain cerebral edema, or resulting from a mild head injury, often goes away on its own, but the patient should always be under 24-hour medical supervision. In such cases, it is necessary to ensure correct blood circulation in the organ to sufficiently saturate the cells with oxygen.

Emergency care for cerebral edema

If any manifestations of cerebral edema appear, you should immediately call an ambulance. Before the doctor arrives you should:

place the patient on his back on a flat surface;
give him sedatives to drink, as well as medicine to lower blood pressure;
cover your head in a circle with ice packs or other items from the refrigerator;
open all the windows in the room.

Ambulance workers must carry out urgent hospitalization in a neurological hospital, where the patient will immediately be given intravenous glucose, piracetam solution, Lasix and glucocorticoids. In addition, he will be wearing an oxygen mask to prevent oxygen starvation of the brain. Subsequently, the patient is sent to the intensive care unit or toxicology department according to indications.

Drug therapy

To effectively treat swelling of the brain, complex drug treatment is carried out:

Dehydration therapy. Aimed at removing excess fluid from brain tissue.
Infusions using loop and osmotic diuretics, hyperosmolar solutions and other drugs that have a stable diuretic effect are indicated as therapeutic procedures.
Oxygenation and improvement of metabolism of brain structures
Using these methods, it is possible to achieve restoration of metabolic processes in organ tissues, cell regeneration, stabilization of membrane structures and strengthening of the vascular wall.
The patient is given invasions of drugs such as Actovegin, Ceraxon, Cortexini hormones of the glucocorticoid group.
Elimination of the cause and relief of accompanying symptoms

Since swelling of the brain always occurs with pronounced manifestations, doctors simultaneously eliminate the existing symptoms along with the main treatment. To solve this problem, antibacterial therapy is often used, and medications are prescribed to detoxify the body.

Surgical removal of lesions is possible only after stabilization and improvement of the patient’s general condition.

Consequences

Even after complete cure of swelling of the brain and removal of the affected areas of the organ, patients rarely manage to return to normal life. There is a great danger of complications and the formation of undesirable consequences in the form of:

systematic headaches;
sleep disorders;
speech, visual and mental abnormalities;
facial asymmetry;
strabismus;
epileptic seizures;
motor dysfunction.

Prognosis for recovery and survival

Toxic and “mountainous” edema of the brain are the least dangerous for humans, and usually respond well to treatment, provided that the patient was taken to the department on time.

For swelling of another origin, the success of therapy depends on the degree of neglect of the pathology. In the early stages of the disease, the painful condition is reversible. As the pathological process progresses, the chances of a full recovery rapidly decrease, and even with the effectiveness of treatment procedures, it will not be possible to restore proper functioning of the brain.

Formed comatose states often cause the death of the patient. It is almost impossible to bring a patient out of a coma with significant organ damage.

In any case, if it was possible to achieve regression of symptoms and elimination of swelling, then patients may subsequently experience residual effects after suffering swelling of the brain. These include:

In severe situations, mental disorders, motor and cognitive dysfunctions are observed, which threaten the person with disability.

Various intracranial pathologies often threaten the development of complications. Among them is cerebral edema, which is an accumulation of fluid in cells and intercellular space (ICD-10 code G93.6).

The causes of cerebral edema are as follows:

cerebral hemorrhages;
neoplasms and metastases;
inflammatory processes (encephalitis, meningitis), abscesses;
traumatic brain injuries (bruises, concussions, fractures, hematomas);
neurosurgical operations;
exogenous intoxication (alcohol, drug or food poisoning);
endogenous intoxication (due to liver or kidney failure, diabetes mellitus);
birth trauma in newborns;
difference in altitude (“mountain” cerebral edema).
severe allergic reactions (Quincke's edema, anaphylactic shock);
acute infections (scarlet fever, severe flu, measles, etc.).

In the case of TBI, ICD-10 classifies the pathology as a class of intracranial injuries, defining the category “Traumatic cerebral edema” (code S06.1), and in newborns – to the class of birth injuries of the central nervous system (P11.0 – “Cerebral edema due to birth injury ").

Mechanisms of pathology

The following types of edema are distinguished:

vasogenic;
cytotoxic;
interstitial.

The pathogenesis of vasogenic is that circulatory disorders occur at the site of the affected brain tissue, which cause dilation of blood vessels and an increase in pressure in them. As a result, liquid components of the blood penetrate the vascular wall and enter the brain tissue. First, perifocal cerebral edema appears (i.e., local), then changes affect healthy areas, and extensive edema forms.

The pathogenesis of cytotoxic is an increase in intracellular water. The factor leading to it is a lack of oxygen and adenosine triphosphate, which leads to an increase in intracellular osmotic pressure and excessive water entry into the cell. Interstitial edema occurs due to the appearance of cerebrospinal fluid in the subependymal tissue. This can happen with hydrocephalus.

In all cases, the brain, expanding, is compressed in a limited space, which leads to increased intracranial pressure, compression of blood vessels, hypoxia and massive death of nerve cells. threatens displacement of brain structures, compression of a vital part - the trunk, entry of the cerebellar tonsils into it, which leads to death.

In alcoholism, extensive cerebral edema appears when the concentration of the substance in the blood is 5–8 g/l; a single dose can vary between 4–12 g/kg (this is approximately 300 ml of ethanol).

Process manifestation

There are clearly expressed symptoms by which one can judge the development of pathology.

Disturbance of consciousness (stunning, stupor, drowsiness, coma, akinetic mutism, waking coma). The more severe the patient’s condition and the more pronounced the signs of changes in consciousness, the stronger the cerebral edema.
The appearance of seizures indicates the progress of the pathological process. Subsequently, they may be replaced by muscle atonia.
Meningeal symptoms may occur. This includes stiffness of the muscles of the neck and sometimes the back. It is also impossible for the patient to straighten his leg, which is bent at the hip joint at a right angle. Brudzinski's symptoms are noted: upper (when the patient's head is bent, his legs bend), middle (the same when pressing on the pubic symphysis), lower (bending one leg leads to bending of the other).
If the patient remains conscious (this rarely happens - with chronic diseases or acute conditions that gradually increase), a headache is observed.
Perifocal cerebral edema, when consciousness is preserved, gives focal symptoms of damage: disorders of speech, vision, coordination, paralysis of one half of the body.
Signs of brain stem damage include paradoxical breathing (when the volume of the chest decreases during inhalation and increases during exhalation), a drop in blood pressure, an unstable pulse and an increase in temperature above 40°C. Their appearance indicates that the life-supporting centers of the body (respiratory, cardiovascular) are under threat.

Cerebral edema is a critical condition. If there is no treatment, coma and death are inevitable. If a person exhibits the main signs (loss of consciousness, convulsions) or suspects the development of a pathological process (severe headache, focal symptoms), you should immediately call an ambulance.

In newborn children, unlike adults, there is a compensation mechanism that allows the brain to expand - soft cartilaginous joints and fontanelles (an example of their location can be seen in the bottom photo).

However, in most cases, the pathology in a small child, due to its lightning-fast course, quickly leads to death.

Therapeutic effects

Treatment and diagnostic procedures (tomography, neurological examination, clinical and biochemical tests) are carried out simultaneously, since cerebral edema is a life-threatening condition.

The main measures to eliminate pathology include several points.

Dehydration treatment is a priority - it rids the cerebral tissue of fluid. It is carried out using intravenous administration of diuretics with drugs that potentiate their effect.
Symptomatic treatment consists of correcting cardiovascular activity, lowering body temperature, removing toxic compounds from the body, and administering antibiotics. Elimination of the cause of the pathology, which is carried out through surgery or drainage, is carried out after stabilization of the condition.
Improving brain metabolism is achieved through oxygenation, artificial ventilation, administration of glucocorticoids and drugs that correct metabolic brain processes.

Sometimes swelling is eliminated through surgery: decompression craniotomy is performed in the fronto-parietal-temporal region on one or both sides. With its help, a “window” is created (by removing a bone fragment), the dura mater is dissected, and then plastic surgery is performed using a graft. This method is used only in extreme cases, when cerebral edema is not relieved by medications, since complications are possible after surgery: damage to the brain and its blood vessels when the dura mater is opened, and swelling of the brain with entrapment in the trepanation “window.”

Possible consequences

The prognosis for developed pathology is usually unfavorable.

In half of the cases, swelling of the brain occurs, its compression and death. The second most common option is the elimination of the pathology with the patient’s disability. Rarely, the consequences of cerebral edema are not observed: this happens with exogenous intoxication (alcohol, other toxic compounds) in young, relatively healthy people. If the dose of toxins is not critical, and cerebral edema is completely eliminated, the patient does not face pathological complications.

The prognosis directly depends on the degree of damage: the more extensive the cerebral edema, the more severe the consequences. They are less pronounced in local lesions in the initial stage.

Common complications:

paralysis - partial (paresis) or complete;
partial or complete aphasia (loss of speech);
dementia (dementia);
amnestic symptoms, decreased concentration;
epilepsy;
headaches, dizziness;
incoordination of movements;
movement disorders;
sleep disorders, mood disorders, clinical depression;
attacks of aggression.

Cerebral edema is a secondary pathology, which in most cases implies an unfavorable prognosis. Regardless of its pathogenesis, there are certain manifestations of this process, the main one of which is the absence of consciousness. It is necessary to treat edema as soon as it is suspected - this increases a person’s chances of survival and minimizing serious consequences. To eliminate the pathology, resuscitation and symptomatic therapy are necessary. Possible surgical options include correction of the underlying disease or decompression craniotomy.

Cerebral edema is a nonspecific pathology in which an increase in tissue volume is observed due to an increase in the amount of fluid contained in them. This pathological condition is not an independent disease, because it is formed due to the influence of various endogenous and exogenous factors.

A disease of this type usually poses a serious danger to a person’s life, because during its development nerves, arteries, tissues, and important brain structures begin to be compressed, which invariably leads to disruption of the central nervous system, visual and speech centers, prostate gland, and many others. the most important systems of the body.

Etiology

There can be many reasons for the development of cerebral edema in children and adults. The most common of them are:

Infections (toxins damage nerve tissue, which leads to the occurrence of an inflammatory process).
Trauma to the brain and spine (for example, swelling of the brain after an accident, surgery, a strong blow to the head, a fall, etc.). The site of injury on the head after an injury in an accident may become very swollen, which usually occurs with a TBI.
Tumor processes (cancer), in particular glioblastoma and cysts, localized in various parts of the brain, which lead to problems with the outflow of cerebrospinal fluid or displacement of brain structures.
Hemorrhagic stroke, penetration of blood into the subarachnoid space.
Embolism of the head vessels with the simultaneous occurrence of ischemic stroke.
Heavy exposure to radiation.
Poisoning with drugs, poisons, toxins (extremely dangerous during pregnancy).
Encephalitis tick bite (the likelihood of dying from such a pathological process is high).
The presence of metastases in the brain due to cancer.
Metabolic encephalopathy (observed in severe renal or liver failure, in the last stages of alcohol dependence, in diabetes).
Eclampsia.
Water intoxication.
Some types of vaccinations (controversial issue).

It happens that the brain often begins to swell in newborns who were born prematurely, or during a pathological course of labor. In this case, swelling in infants is traumatic.

The brain may begin to swell due to exposure to a number of toxins: gasoline, ethyl alcohol (and other types of alcohols), phenol, cyanide, etc. A huge number of medications that are used to treat various diseases and have a pronounced neurotoxic effect, in cases of overdose, can also lead to toxic cerebral edema. This category of medications includes: tranquilizers, antipsychotic drugs, tricyclic antidepressants, antihistamines.

Pathogenesis

Cerebral edema develops against the background of the appearance of various microcirculatory disorders that form at the site of the pathological focus in the brain structures (after an ischemic stroke, head trauma, inflammatory process, etc.).

Local perifocal swelling begins to develop. If the course of the disease is severe, then in the absence of treatment or the wrong choice of therapeutic technique, the appearance of disturbances in the functioning of blood vessels is observed.

Hydrostatic intravascular pressure also rises. Due to these processes, part of the blood exits through the vascular walls, penetrating the cerebral tissue. This, in turn, leads to the development of generalized edema and subsequent swelling of the brain.

In the development of pathology, generally speaking, three main triggers play a major role:

Increased permeability of vascular walls in the brain.
Arterial hypertension.
Vasodilation, which causes a pronounced increase in pressure in the capillaries of cerebral tissue.

It is also worth noting that there is a certain tendency of brain tissue to accumulate fluid if there is a lack of blood supply.

In an adult and a school-age child, intracranial pressure indicators vary from 4 to 16 mmHg. When coughing or sneezing, there is an increase in pressure in adults and children to a level of 45-55 mmHg, but this short-term process does not lead to disturbances in the functioning of the central nervous system.

With the development of swelling in the brain, intracranial pressure rapidly increases due to the enlargement of cerebral tissue. As a result of the fact that the pathological area begins to swell, the vessels are compressed, which causes aggravation of microcirculatory disorders. Against the background of all this, the development of ischemia of brain cells is also observed. Nerve tissue cells begin to die in huge quantities due to metabolic disorders (usually due to oxygen deficiency). The cerebellar tonsils become wedged into the visual and speech centers, which leads to malfunctions in their functioning. Moreover, only a slight swelling appears on the head externally (and not always).

In the case of a rapid increase in intracranial pressure, cerebral structures that lie below the tumor also often move. There is a possibility of infringement of the brain stem in the occipital part. The thermoregulatory, cardiovascular, and respiratory centers are located in this zone. That is why, if their work is disrupted, a person’s death can occur.

Types of cerebral edema

Before we talk about the symptoms of cerebral edema, it should be noted that this pathology can develop in four main forms:

Cytostatic.
Vasogenic.
Osmotic.
Interstitial.

Most often, people experience vasogenic edema, which begins to develop against the background of an increase in the level of permeability of the blood-brain barrier. An important pathological process in this disease is the transition of fluid from the vessels into the white matter of the brain. In this case, swelling usually begins to appear at the site of the tumor process, ischemia, the area of the operation or abscess manifestations.

The cytostatic form is a consequence of disruption of the functioning of glial cells, as well as disorders in the processes of osmoregulation of neuronal membranes. Development is usually observed in the gray matter. The main causes of cerebral edema in this case are: intoxication, ischemia, oxygen deficiency in brain tissue, and penetration of viruses. This pathology is partly treated by specialists in the field of neurology.

The osmotic form manifests itself with an increase in osmolarity of cerebral tissues. In this case, the normal functioning of the blood-brain barrier is almost never disrupted. The disease develops against the background of encephalopathy, improperly performed hemodialysis, polydipsia, and drowning.

The interstitial form is notable in that edema begins to form near the cerebral ventricles when some of the cerebrospinal fluid begins to penetrate their walls.

Symptoms

Despite the causes and consequences of cerebral edema, in any case, the clinical picture of the disease will include focal and general cerebral symptoms. The order in which signs of pathology appear will depend on the underlying causes of hemorrhage. The form of the disease can be lightning fast (immediate help is required, there is a real struggle for the patient’s survival, the probability of death is high) and gradual (there is a short time period that allows you to easily prevent the death of the patient).

The main symptoms of edematous type cerebral hematoma include:

Darkness of consciousness. This symptom will manifest itself in any case, regardless of the cause of the disease. Clouding of consciousness can be expressed in different ways: seizures of epilepsy, congestion, stupor, coma, clouding of consciousness, fainting. The development of swelling will always be accompanied by an increase in the depth of a person’s fainting state.
Pain in the head. Headaches as a result of the development of edema are observed only in those patients who have a history of an acute form of some kind of brain pathology.
Symptoms of meningitis. With the development of inflammation, tumor, and edema in the brain structures, meningeal symptoms often appear. Their presence in elderly patients should be alarming, because such symptoms are extremely dangerous for them.
Focal symptoms. Typically, signs of this type are recorded at the stage of development of swelling. The patient may have impaired movement of the limbs, and paralysis of half the torso and face may develop. Problems with the functioning of the visual and speech centers, visual and audio hallucinations, and difficulties with coordination of movements are also often observed. Traditionally, cerebral edema, which leads to loss of consciousness in patients, leads to the inability to conduct higher nervous activity.
Cramps. As the area of swelling increases, brief cramps may occur that last only a few minutes. The highest degree of this symptom is the development of muscle atony.
Decreased blood pressure, unstable pulse. Dangerous symptoms, which clearly indicate that the edema spreads to the trunk, where the main central nervous system centers responsible for the vital functions of the body are located.

The consequences of cerebral edema will directly depend on the therapeutic effect, the form of pathology, the age of the patient and a number of other factors. Moreover, it is extremely difficult to eliminate edema completely (this is only possible in young patients). Most often, swelling cannot be completely removed, so the consequence of the disease is disability.

Diagnostics

Various modern methods are used to diagnose the disease: MRI, CT, ultrasound and many others. If the form of the pathology is not fulminant, then a neurologist may suspect the presence of the disease, who will note the progress of deterioration of the patient’s condition, the increase in processes of impaired consciousness along with the symptoms of meningitis.

To confirm the diagnosis, computed tomography methods are also used.

Lumbar puncture is not performed in all cases, because there is a certain danger that the cerebral structures, as a result of developing edema, change their location simultaneously with compression of the trunk. They also help in making a diagnosis: blood biochemistry, medical history, analysis of neurological status, neuroimaging examinations.

Considering the fact that cerebral edema causes serious complications, and the patient himself often requires emergency care, diagnosis should take a minimum amount of time. Diagnostics is performed in a hospital setting with simultaneous implementation of all necessary therapeutic measures. Afterwards the patient is placed in intensive care or intensive care.

Treatment

If a person shows signs of cerebral edema after an accident, a blow, a fall, or for any other reason, then a whole range of measures must be taken. If symptoms are severe, it is necessary to ensure a flow of fresh air to the patient and ensure that vomit does not enter the respiratory tract.

If you have a high temperature, it is recommended to cool your head with an ice pack. Due to this, blood vessels will also dilate, which will improve blood circulation. If possible, the person must wear an oxygen mask.

Immediately after first aid is provided, the patient must be transported to the hospital in a supine state.

When treating cerebral edema, dehydration therapy is often used, with the help of which excess fluid is removed from the tissues. The following medications are used for therapy:

Loop diuretics (in high dosages, which allows for the formation of a pronounced diuretic effect).
Osmotic diuretics (usually prescribed immediately after diagnosis; together with loop drugs, osmotic drugs can provide a high-quality dehydration effect).
Hypersmolar solutions (increase plasma pressure, improve the functioning of diuretics, and ensure the supply of useful substances to nerve cells).
L-lysine escinate (allows you to remove excess fluid from brain tissue without a pronounced diuretic effect, reduces the symptoms of swelling in the intracerebral space, relieves the severity of inflammation).

In case of cerebral edema, it is extremely important to quickly establish the cause of the development of the pathology, as well as begin treatment for accompanying symptoms. Therefore, after admission to intensive care, doctors monitor the patient’s heart function, symptoms of intoxication, body temperature, treat with antibiotics, remove toxins from the body, and remove tumor growths.

Doctors also often perform operations to drain the cerebrospinal fluid (for this, bypass paths are formed for the flow of cerebrospinal fluid). From a surgical point of view, this procedure reduces intracranial pressure, reduces swelling, and partially removes swelling. In the postoperative period, long-term rehabilitation is indicated. In the presence of oncology (if this is the cause of edema), radiation therapy is mandatory.

It is impossible to treat cerebral edema with folk remedies at home - if there is a suspicion of such a pathology, the patient is given emergency care and sent to intensive care, where therapy can last more than one day. It will not be possible to remove an internal hematoma using folk remedies. In the absence of adequate treatment within a few days after the onset of pathology, patients are highly likely to die due to complications that arise.

Recovery

The processes of complications, their severity and severity, will directly depend on the quality and efficiency of medical care. Restorative measures after the operation are carried out in the hospital. If during the development of brain swelling the visual and speech centers and the area of the musculoskeletal system were affected, then the person will have to learn to walk and talk again.

The consequences after the acute stage of the disease will not always be serious, but in some cases there is a possibility of death. A pathology of this type, taking into account the individuality of clinical manifestations and the many causes of its occurrence, almost always remains unpredictable for doctors, therefore, in any case, three main paths of the disease are always considered:

Subsequent development of pathology, compression of brain structures by edema, death of a person.
Elimination of swelling, patient disability.
Elimination of edema without any serious consequences.

According to world statistics, five out of ten patients who have been diagnosed with cerebral edema die within a few days after the onset of the pathological process.

Brain edema, the causes and consequences of which we will consider in this article, is the body’s reaction to excessive stress, injury and infection. As a rule, this process happens quite quickly. At the same time, the cells themselves and the space between them are filled with an excess amount of fluid, and the brain as a result increases in volume, which, in turn, causes an increase in intracranial pressure, a deterioration in cerebral circulation and entails cell death.

This condition, as you understand, requires mandatory and urgent medical care in order to avoid serious consequences and death.

Causes of edema

The causes of cerebral edema may be different and lie, for example, in impaired cerebral circulation expressed by ischemic or hemorrhagic stroke, in traumatic brain injury, in the presence of an intracranial cancer tumor or metastasis from tumors of any location.

Inflammatory processes in the brain or its membrane (meningitis or encephalitis), fractures of the skull vault with damage to the brain matter, as well as general diseases in the form of severe infections, cardiovascular pathologies or extensive burns can also cause cerebral edema.

In addition, even a severe allergic reaction in the stage of anaphylactic shock or drug and alcohol intoxication can provoke the development of this pathology.

What is the main danger of edema?

Swelling of any tissue in the human body is a fairly common and completely natural phenomenon, which, as a rule, passes without any special consequences. But the brain is in a limited space, in a dense cranium, which cannot increase its volume under the pressure of its tissues.

Whatever the causes of cerebral edema, they ultimately lead to compression of its substance in a narrow space. And this circumstance entails the greatest danger: neuronal ischemia worsens, the progression of edema intensifies, and at some point brain functions are lost.

Cerebral edema during stroke: what causes it

One of the common causes of the mentioned edema in a patient is hemorrhagic or unfortunately, these types of circulatory disorders are almost always accompanied by the described problem, expressed to one degree or another and which is a kind of indicator of the severity of the pathological process.

Causes of cerebral edema in newborns

Separately, it is worth considering this pathology in newly born children. The reasons that cause cerebral edema in them most often lie in the severe course of labor in the mother and the birth trauma of the baby. But it can also be caused by congenital malformations or acquired diseases. Abscesses, tumors, intrauterine hypoxia - all this can cause cerebral edema in an infant.

By the way, the course of the described pathology in children looks somewhat different than in adults, since their body still has very limited capabilities for maintaining vascular tone, regulating intracranial pressure and cerebrospinal fluid dynamics. The child’s only salvation in such a situation lies in the peculiarities of the connection of the skull bones, between which he has either soft cartilaginous tissue or a gap (fontanelles). By the way, this anatomical feature protects the baby from compression and swelling of the brain, which could end with any cry of the baby.

Features of symptoms of cerebral edema in infants

Cerebral edema in newborns has a lightning-fast course. At the beginning of the development of pathology, the baby, as a rule, becomes lethargic, sleepy, he may have convulsions, and lose consciousness. In some children, on the contrary, swelling causes an excited state, expressed by constant non-stop crying.

At the same time, the fontanel swells even in a calm state, the volume of the head increases, the baby begins to vomit, and the temperature rises.

In newborns with cerebral edema, a characteristic sign of this pathology is a very rapid deterioration in the general condition and, unfortunately, in many cases it ends in death.

Cerebral edema: consequences

The sooner a patient with this diagnosis is provided with qualified medical care in full, the higher his chances of recovery. But quite often the recovery is only partial - it all depends on the severity of the pathological process.

The consequence is sometimes, for example, the development of epilepsy caused by impaired blood supply to certain parts of the brain. The patient may experience increased intracranial pressure, which in turn leads to dizziness, disturbances of consciousness, and even decreased social communication skills.

In many patients diagnosed with cerebral edema, the consequences of the pathology are manifested in the adhesive process in the ventricles, between the membranes or in the cerebrospinal fluid space, which leads not only to periodic headaches, but also to a depressive state and a disorder of neuropsychic activity.

If the swelling was prolonged, then its consequences may be impaired brain function and a decrease in a person’s mental abilities.

What are the consequences of cerebral edema in children?

The consequences of the disease in question in children can also be serious and depend on the severity of the disease.

These include the development of cerebral palsy and hydrocephalus, epilepsy, as well as disorders of the formation of internal organs.

Swelling of the brain in some children can cause problems with speech and coordination of movement. The pathology suffered, unfortunately, causes neuropsychic instability and mental retardation in some patients.

From the above, it is clear that cerebral edema in children is a very serious pathology that requires constant monitoring of the child by a neurologist and pediatrician, and its duration depends on the severity of the consequences of the disease.