Cerebral edema: types, symptoms, causes and treatment
This cerebral accident appears when a liquid fills parts of the encephalon in which it is in excess.
If someone tells us that they have fluid retention we are probably thinking of a person with swollen legs or some part of the body swollen and swollen. Said in this way it may seem something not very relevant, easily treatable and that can hardly be a nuisance, as in fact it is so in many cases. However, this fluid retention or edema can be very dangerous depending on where it occurs. Because it is not the same to have fluid retention in the legs or ankles than to have it in organs such as the lung.
One of the most serious and dangerous situations that can occur in this sense is the presence of a cerebral edema, which can even be cause of death..
Defining the concept of edema
Before talking about cerebral edema itself, it is first necessary to understand what we are referring to when we speak of the term edema. It is understood as such the existence of a swelling or inflammation of soft tissues due to the accumulation of fluid in or on due to the accumulation of fluid in or between its cells, due to imbalances in the amount of interstitial fluid leaving or entering the cells.
This inflammation can have a great variety of causes and can be located in almost all types of soft tissues of the organism, and can have repercussions of different consideration depending on the type of tissue affected.
Cerebral edema: main symptoms
One of the locations where edema can occur, as well as one of the most dangerous, is in the brain tissue. In cerebral edema we find an increase and accumulation of fluid between brain cells that generates a swelling of sufficient magnitude to cause clinical symptoms. that generates a swelling of sufficient magnitude to cause clinical symptoms.
This swelling is so severe in this case because the brain does not float in a vacuum, but is surrounded by the brain cells.It is surrounded by a bony structure that protects it but at the same time limits it: the skull. The accumulation of fluid can cause compression of the brain mass against the walls of the skull, which can lead to the death of neurons.
It also also greatly increases the level of intracranial pressure as electrolyte balance is not maintained The accumulation of fluid can cause compression of the brain mass against the walls of the skull, which can lead to the death of neurons. Finally, the compression may affect the Blood vessels, preventing oxygen from reaching any of the brain regions, and the brain may end up drowning.
Depending on the brain regions compressed, symptoms may vary greatly. Dizziness, fatigue and weakness usually appear, as well as a possible alteration of the level of consciousness, headaches, gastrointestinal symptoms such as nausea and/or vomiting or perceptual disturbances. Breathing may accelerate and even convulsions may occur.
Related to the alterations of consciousness, in severe cases, coma or even death may occur if the nuclei of the brain are compressed. if the nuclei responsible for maintaining the cardiac and respiratory rhythm are compressed. In some cases, brain herniation or permanent loss of relevant functions may occur.
In addition to these symptoms, the presence of cerebral edema can lead to death or some type of physical, mental or sensory disability. the appearance of some type of physical, psychic or sensory disability.It can greatly alter the normal functioning of the person, either temporarily or permanently.
Types of cerebral edema
There is no single type of cerebral edemaWe can find different typologies depending on where and why the imbalance and fluid accumulation occurs. The fluid can accumulate both inside the cells and in the extracellular space.
1. Cytotoxic edema
In this type of edema, swelling occurs when fluid accumulates inside the cells themselves, the cells have abnormally taken up an excessive amount of interstitial fluid.. It is usually caused by a malfunction of the sodium/potassium pumps and channels through which fluid enters and leaves the cells. We are faced with a problem of regulation of cellular metabolism and maintenance of homeostasis. The consumption of some toxic element may be one of its causes.
2. Vasogenic edema
This is considered to be edema that occurs as a consequence of an increase in the permeability of the nervous system, due to the rupture of the blood-brain barrier. Generally we find that blood plasma penetrates into the parenchyma or extracellular space surrounding nerve cells and surrounding the nerve cells and accumulates in it. This is the most common type of cerebral edema. Tumors, cerebrovascular accidents and cranioencephalic trauma tend to be some of its most common causes.
3. Hydrocephalic or interstitial edema
Edema generated by the obstruction of the channels through which cerebrospinal fluid circulates, causing the cerebral ventricles or the areas near the blocked area to swell. It appears in hydrocephalus.
Possible causes
There are a number of possible causes of cerebral edema. Some of the most frequent are the following.
Craniocerebral trauma.
One of the causes that may be easier to identify has to do with the existence of a trauma to the head. Such a blow causes the rupture of blood vessels, flooding the brain with blood.flooding the brain with blood. When trying to absorb the excess liquid, the cells would swell.
2. Cerebrovascular accident
The existence of a cerebral hemorrhage or blockage of the cerebrovascular system is one of the best known causes of cerebral edema. These accidents would either cause fluids to be extravasated directly into the brain or nerve cells to die and rupture, causing fluid accumulation.
3. Viral or bacterial infections
Another possible cause of cerebral edema may be an infection. The cells are damaged and break, generating an imbalance in the level of cerebral fluid. Within this group of causes we find very different diseases, from meningitis to Reye's syndrome..
4. Tumors
The appearance of neoplasms, whether benign or malignant.The brain fluid may compress the blood vessels or block the passage of cerebrospinal fluid, which may result in the appearance of fluid accumulation in some areas of the brain.
5. Hypoxia derived from altitude
This type of edema occurs in subjects such as climbers and divers. The main cause is the existence of a sudden variation of the atmospheric pressure in the face of a rapid ascent.The main cause is the existence of a sudden change in atmospheric pressure: in the absence of oxygen, the body tries to dilate the arteries and veins of the nervous system, but if this situation is prolonged or the change is generated very quickly, this dilatation will generate homeostatic difficulties that will culminate in the accumulation of fluids in the brain.
6. Hyponatremia
Disorder that occurs in the absence of a sufficient level of sodium in the blood, which the organism tries to compensate by causing an increase in the entry of liquid into the interior of the cells.
7. Intoxication
The consumption of a toxic substance or poisoning can generate alterations in the nervous system can generate alterations in the nervous system that provoke the existence of imbalances in the levels of intra or extracellular liquid.
Treatment
The treatment of a cerebral edema is essential and requires prompt professional action in order to avoid death or irreparable damage to the patient.
The first step to be taken is the elimination of fluid accumulation and reduction of swelling, and it is essential to monitor vital signs at all times. The application of artificial respiration mechanisms may be necessary to maintain a constant and sufficient flow of oxygen to the patient. to maintain a constant and sufficient flow of oxygen.
In cases where the patient's life is in danger, surgery is usually used immediately to control the level of inflammation by draining the fluid, or resection of part of the skull to release and reduce intracranial pressure. Once the patient is stabilized, it is necessary to analyze what has generated the problem in order to treat its causes.
It has also been shown that the induction of a controlled hyperventilation the formation of cerebral edema. However, it must be very controlled, since depending on how much and for how long it is performed, it can have very harmful effects.
Both in this and in other cases in which surgery is not used, the use of different drugs is common. For example, the application of corticosteroids is very frequent. in order to reduce the level of intracranial pressure in those cases in which the problem is not of cytotoxic or hemorrhagic origin. Osmotics and diuretics may also be used to facilitate the expulsion of fluids.
Bibliographic references:
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- Jaramillo, J.J. (1997). Fluid management in the neurosurgical and head trauma patient. Memorias XXIII, Annual Refresher Course in Anesthesiology. Mexican Society of Anesthesiology.
- Jha, S. K. (2003). Cerebral edema and its management. Medical Journal Armed Forces India, 59(4), 326-331.
- Kasper, D. (2015). Harrison's principles of internal medicine (19th ed.). New York, New York: McGraw-Hill, Medical Pub. Division.
- Milhorat, T. H.; Johnson, W. D.; Dow-Edwards, D. L. (1989). Relationship between edema, blood pressure, and blood flow following local brain injury. Neurol. Res.;11:29
- Renkin, E.M. (1994) Cellular aspects of transvascular exchange: a 40-year perspective. Microcirculation 1(3):157–67.
(Updated at Apr 14 / 2024)