Brain edema develops quickly. Why does cerebral edema occur and what measures to take?

Cerebral edema (CE) is a pathological condition that is formed as a result of exposure to various factors damaging brain structures: traumatic injury, compression by a tumor, penetration of an infectious agent. Adverse influence quickly leads to excessive fluid accumulation, increased intracranial pressure, which leads to the development of severe complications, which, in the absence of emergency therapeutic measures, can result in the most tragic consequences for the patient and his relatives.

Causes of GM swelling

Normally, intracranial pressure (ICP) in adults is between 3 and 15 mm. Hg Art. In certain situations, the pressure inside the skull begins to rise and create conditions unsuitable for the normal functioning of the central nervous system (CNS). A short-term increase in ICP, which is possible with coughing, sneezing, heavy lifting, or increased intra-abdominal pressure, as a rule, does not have time to have a detrimental effect on the brain in such a short period of time, and therefore cannot cause cerebral edema.

It’s another matter if damaging factors leave their influence on brain structures for a long time and then they become the causes of a persistent increase in intracranial pressure and the formation of a pathology such as cerebral edema. Thus, The causes of swelling and compression of the brain can be:

Penetration of neurotropic poisons, viral and bacterial infections into the GM substance, which happens in the case of poisoning or various kinds of infectious and inflammatory diseases (meningitis, brain abscesses), which can become a complication of influenza and purulent processes localized in organs located in close proximity to brain (angina, otitis media, sinusitis);
Damage to the substance of the brain and other structures as a result of mechanical impact (TBI, especially with a fracture of the bones of the vault or base of the skull, and);
In newborn children - birth injuries, as well as pathology of intrauterine development, the cause of which was the illness suffered by the mother during pregnancy;
, primary or metastases from other organs, compressing nervous tissue, preventing the normal flow of blood and cerebrospinal fluid, and thereby promoting the accumulation of fluid in the brain tissue and increasing ICP;
Operations performed on brain tissue;
(stroke) of ischemic (cerebral infarction) and hemorrhagic (hemorrhage) type;
Anaphylactic (allergic) reactions;
Climbing to high altitudes (above one and a half km) - mountain edema in persons involved in mountaineering;
Liver and kidney failure (in the stage of decompensation);
Withdrawal syndrome in alcoholism (alcohol poisoning).

Any of the listed conditions can cause cerebral edema, the formation mechanism of which in all cases is, in principle, the same, the only difference being that the edema affects only a separate area or spreads to the entire substance of the brain.

A severe scenario for the development of acute brain injury with transformation into brain swelling threatens the death of the patient and looks like this: every cell of the nervous tissue is filled with fluid and stretches to unprecedented sizes, the entire brain increases in volume. Ultimately, the brain, limited by the cranium, begins to not fit in the space intended for it (brain swelling) - it puts pressure on the bones of the skull, causing it to compress itself, since the hard cranium does not have the ability to stretch parallel to the increase in brain tissue, which is why the latter is subjected to injury (compression of the brain). In this case, intracranial pressure naturally increases, blood flow is disrupted, and metabolic processes are inhibited. Cerebral edema develops rapidly and without the urgent intervention of medications, and sometimes surgery, it can return to normal only in some (not severe) cases, for example, when climbing to a height.

Types of cerebral edema arising from the causes

increase in intracranial pressure due to hematoma

Depending on the reasons for the accumulation of fluid in the brain tissue, one or another type of edema is formed.

The most common form of brain swelling is vasogenic. It comes from a disorder of the functionality of the blood-brain barrier. This type is formed due to an increase in the size of the white matter - with TBI, such edema is already able to make itself known before the end of the first day. Favorite places for fluid accumulation are nervous tissues surrounding tumors, areas of operations and inflammatory processes, areas of ischemia, and areas of injury. Such swelling can quickly turn into compression of the brain.

Reason for formation cytotoxic edema most often are such pathological conditions as hypoxia (carbon monoxide poisoning, for example), ischemia (cerebral infarction), which occurs due to blockage of a cerebral vessel, intoxication, which develops as a result of the ingestion of substances that destroy red blood cells (erythrocytes) into the body (hemolytic poisons), as well as other chemical compounds. In this case, cerebral edema occurs mainly due to the gray matter of the brain.

Osmotic a variant of cerebral edema results from increased osmolarity of the nervous tissue, which can be caused by the following circumstances:

Interstitial type of edema - its cause is the penetration of fluid through the walls of the ventricles (lateral) into the surrounding tissues.

In addition, depending on the extent of the spread of edema, this pathology is divided into local and generalized. Local OMS is limited to the accumulation of fluid in a small area of the medulla, and therefore does not pose such a danger to the health of the central nervous system as generalized swelling of the brain, when both hemispheres are involved in the process.

Video: lecture on variants of cerebral edema

How fluid accumulation in brain tissue may manifest itself

Probably the most typical, although far from specific, symptom characterizing the degree of fluid accumulation in the brain is a severe headache, which is often not relieved by almost any analgesics (and if they are relieved, it is only for a short time). Such a symptom should especially seem suspicious if there has been a recent traumatic brain injury and the headache is accompanied by nausea and vomiting (also typical signs of TBI).

Thus, the symptoms of AGM are easy to recognize, especially if there were prerequisites for this (see above):

Intense headache, dizziness, nausea, vomiting;
Absent-mindedness, impaired attention, inability to concentrate, forgetfulness, decreased communicative (individual) abilities to perceive information;
Sleep disturbance (insomnia or drowsiness);
Fatigue, decreased physical activity, constant desire to lie down and abstract from the world around you;
Depression, state of depression (“the world is not nice”);
Visual impairment (squint, floating eyeballs), orientation disorder in space and time;
Uncertainty in movements, changes in gait;
Difficulty speaking and communicating;
Paralysis and paresis of the limbs;
The appearance of meningeal signs;
Reduced blood pressure;
Heart rhythm disturbances;
Convulsions are possible;
In especially severe cases - clouding of consciousness, respiratory and cardiac dysfunction, coma.

If the brain is swollen and there is no proper treatment, the patient can expect the most dire consequences.– the patient may fall into a stupor, and then into a coma, where there is a very high probability of respiratory arrest and, consequently, the death of a person as a result of this.

It should be noted that in each period of progression of increased intracranial pressure (development), a certain protective mechanism is activated. The capabilities of the complex of compensatory mechanisms are determined by the ability to adapt under conditions of fluid accumulation in the craniospinal system and an increase in brain volume.

Diagnosis and determination of the causes of edema and swelling of the brain, as well as the degree of danger for the patient, is carried out using a neurological examination, biochemical blood tests and instrumental methods (basically, all hopes are for magnetic resonance or computed tomography and laboratory).

How to recover?

Brain edema, which has formed in a climber due to the desire to quickly gain height, or the accumulation of fluid in a separate area of the brain (local edema), which has arisen for another reason, may not require hospital treatment and will go away in 2-3 days. True, a person will be prevented from being particularly active by the symptoms of AMS, which will still be present (headache, dizziness, nausea). In such a situation, you will have to lie down for several days and take pills (analgesics, antiemetics). But in severe cases, treatment may not even be limited to conservative methods - sometimes surgical intervention is required.

To treat cerebral edema, conservative methods are used:

Osmotic diuretics (mannitol) and loop diuretics (Lasix, furosemide);
Hormone therapy, where corticosteroids (for example, dexamethasone) prevent the expansion of the area of edema. Meanwhile, it should be borne in mind that hormones are effective only in the case of local damage, but do not help with the generalized form;
Anticonvulsants (barbiturates);
Medicines that suppress agitation, have muscle relaxant, sedative and other effects (diazepam, relanium);
Vascular agents that improve blood supply and nutrition to the brain (trental, chimes);
Inhibitors of proteolytic enzymes that reduce the permeability of vascular walls (contrical, aminocaproic acid);
Medicines that normalize metabolic processes in the brain (nootropics - piracetam, nootropil, cerebrolysin);
Oxygen therapy (oxygen treatment).

If conservative therapy is insufficiently effective, the patient, depending on the form of edema, is given surgical intervention:

Ventriculostomy, which is a minor operation that involves draining cerebrospinal fluid from the ventricles of the brain using a hollow needle and catheter;
Cranial trephination, which is performed for tumors and hematomas (eliminates the cause of OGM).

It is clear that for such treatment, where surgery is not excluded, the patient is required to undergo mandatory hospitalization. In severe cases, the patient should generally be treated in an intensive care unit, since it may be necessary to maintain basic body functions with the help of special equipment, for example, if a person cannot breathe on his own, he will be connected to a ventilator.

What could be the consequences?

At the beginning of the development of the pathological process, it is premature to talk about the prognosis - it depends on the cause of the formation of edema, its type, localization, rate of progression, general condition of the patient, the effectiveness of therapeutic (or surgical) measures, and, possibly, on other circumstances that are immediately difficult notice. Meanwhile, the development of OGM can go in different directions, and the prognosis, and then the consequences, will depend on this.

No consequences

With relatively minor swelling or local damage to the brain and effective therapy, the pathological process may not leave any consequences. This chance is available to young healthy people who are not burdened with chronic pathology, but who, by chance or on their own initiative, received a mild TBI, which was complicated by edema, as well as who took alcoholic beverages in large doses or other neurotropic poisons.

Possible disability group

Swelling of the brain of moderate severity, which developed as a result of a head injury or an infectious-inflammatory process (meningitis, encephalitis) and was promptly eliminated using conservative methods or surgery, has a quite favorable prognosis; after treatment, neurological symptoms are often absent, but sometimes they cause to obtain a disability group. The most common consequences of such OGM can be considered recurrent headaches, fatigue, depressive states, and convulsions.

When the prognosis is extremely serious

The most terrible consequences await the patient when the brain swells and is compressed. The prognosis here is serious. Displacement of brain structures (dislocation) often leads to cessation of respiratory and cardiac activity, that is, to the death of the patient.

OGM in newborns

In most cases, such pathology in newborns is registered as a consequence of birth trauma. The accumulation of fluid and an increase in brain volume leads to an increase in intracranial pressure, and, therefore, cerebral edema. The outcome of the disease and its prognosis depend not only on the size of the lesion and the severity of the condition, but also on the efficiency of doctors in providing medical care, which must be urgent and effective. The reader can find a more detailed description of birth injuries and their consequences in. However, here I would like to dwell a little on other factors that form such a pathology as OGM:

Tumor processes;
(oxygen starvation);
Diseases of the brain and its membranes of an infectious-inflammatory nature (meningitis, encephalitis, abscess);
Intrauterine infections (toxoplasmosis, cytomegalovirus, etc.);
Late gestosis during pregnancy;
Hemorrhages and hematomas.

Cerebral edema in newborns is divided into:

Regional (local), which affects only a certain area of the GM;
Widespread (generalized) OGM, developing as a result of drowning, asphyxia, intoxication and affecting the entire brain.

Symptoms of increased ICP in children in the first month of life are determined by complications such as infringement of the medulla oblongata, which is responsible for thermoregulation, respiratory function and cardiac activity. Of course, these systems will experience suffering first of all, which will be manifested by such signs of trouble as increased body temperature, almost continuous screaming, anxiety, constant regurgitation, bulging fontanel, and convulsions. What's the worst thing - this pathology during this period, due to respiratory arrest, can easily lead to the sudden death of the baby.

The consequences of intracranial hypertension may become apparent as the child grows and develops:

Frequent syncope (fainting) conditions;
Convulsive syndrome, epilepsy;
Increased excitability of the nervous system;
Delayed growth and mental development (impaired memory and attention, mental retardation);
Cerebral palsy (cerebral palsy);
Consequences of leukomalacia detected in newborns (brain damage caused by ischemia and hypoxia), if it was accompanied by cerebral edema.

Cerebral edema in newborns is treated with diuretics, which help remove unnecessary fluid, corticosteroids, which inhibit the further development of edema, anticonvulsants, vascular agents and angioprotectors, which improve cerebral circulation and strengthen vascular walls.

Finally, I would like to remind the reader once again that the approach to the treatment of any pathology in newborns, adolescents and adults, as a rule, varies significantly, so it is better to entrust this matter to a competent specialist. If in adults a small (local) cerebral edema can sometimes go away on its own, then in newborns you shouldn’t hope for a chance; in children in the first days of life, due to the imperfection of the craniospinal system, cerebral edema has a lightning-fast course and at any moment can cause very sad outcome. In young children, this is always a condition that requires urgent, highly qualified care. And the sooner she arrives, the more favorable the prognosis, the greater the hope for a full recovery.

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Currently answering questions: A. Olesya Valerievna, candidate of medical sciences, teacher at a medical university

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To describe it in simple terms, cerebral edema is a disease in which the normal outflow of cerebrospinal fluid is disrupted. As a result of pathological changes, pressure on tissue increases, blood circulation becomes difficult and necrotic phenomena are observed. In the absence of adequate therapy, edema is fatal.

What is cerebral edema

In a normal state, cerebrospinal fluid constantly circulates in the intershell spaces of the brain, supplying tissues with nutrients and providing additional protection from mechanical damage. As a result of unfavorable factors, the volume of cerebrospinal fluid begins to increase, which leads to pathological changes and disorders.

Symptoms of edema appear almost immediately. The disease progresses rapidly. The patient's condition is gradually deteriorating. If the disease develops unfavorably, death occurs.

Types of cerebral edema

The International Classification of Diseases describes in detail the signs and pathogenesis of edema, which greatly facilitates the diagnosis of disorders and makes it possible to identify abnormalities in the early stages of development.

Depending on its nature, it is customary to distinguish several types of swelling:

Vasogenic edema - pathological disorders are preceded by increased capillary permeability. The result is an increase in the volume of white matter. Perifocal cerebral edema of the vasogenic type occurs as a consequence of internal hemorrhages, the development of tumor formations and lesions of the central nervous system.
Cytotoxic edema is the result of destruction of the structure of brain cells due to toxic poisoning. Pathological changes are reversible only in the first 6-8 hours. Critical changes occur in tissue metabolism. The causes of cerebral edema are poisoning, radiation and the development of coronary artery disease.
Hydrostatic edema - appears in disorders characterized by increased ventricular pressure. This type of swelling is observed mainly in newborns. Periventricular cerebral edema is less common in adults, mainly due to trauma and surgery.
Osmotic edema occurs when the ratio of plasma and brain tissue deviates from the norm. Pathology appears as a complication of water intoxication of the central nervous system, metabolic encephalopathy, hyperglycemia and liver failure.

Cerebral edema in newborns can be classified as a separate category. Pathological changes are traumatic in nature or occur due to disturbances during fetal development, hypoxia, difficult childbirth, etc.

After diagnosing the disease and the factors causing swelling, a code according to ICD 10 is assigned and the appropriate course of therapy is prescribed.

What causes cerebral edema?

Brain swelling can be due to various causes of traumatic and infectious nature. It is customary to distinguish between eight main factors that cause rapidly progressive swelling of brain tissue:

The clinical manifestations and prognosis of treatment are influenced by the etiology and pathogenesis of the disease. The degree of swelling and existing complications influence the choice of therapy and medications.

How does cerebral edema manifest?

Timely detection of signs of cerebral edema in adults and newborns makes it possible to provide effective and quick assistance, which often contributes to the patient’s full recovery.

Symptoms of pathological disorders are:

Signs of developing edema also include fainting, difficulty speaking, breathing and other manifestations. The intensity of symptoms gradually increases. Brain edema causes the death of nerve tissue, so the patient experiences symptoms characteristic of problems with the conduction function of the central nervous system.

Why is cerebral edema dangerous?

Unfortunately, even timely detected disease does not guarantee complete healing of the patient. The main task of medical personnel is to prevent further spread of swelling and combat possible complications.

The mechanism of edema development is associated with the development of necrotic phenomena. It is impossible to completely restore dead nerve cells and soft brain tissue. The consequences depend on the degree of damage and the damaged area.

Even after effective therapy, the patient experiences the following complications:

In severe cases, with strokes and tumor diseases, cerebral edema is terrible because it leads to partial or complete paralysis of the limbs and disability.

Oncological diseases, even after tumor removal, are fatal in 85% of cases. Recent studies have established a relationship between coma and swelling of brain tissue.

Coma and cerebral edema

Extensive swelling is accompanied by strong pressure on the soft tissue of the brain. The body's protective functions are activated, forcing the human body to maintain necessary, vital indicators and not waste nutrients.

Coma due to edema is a protective reaction. First, the patient falls into an unconscious state. If prompt assistance is not provided, coma is diagnosed. Depending on the degree of damage and the factors that caused changes in brain function, the patient is hospitalized in the appropriate department of the hospital.

Cerebral edema in a newborn

Brain edema in a newborn most often occurs as a consequence of birth trauma. But also predisposing factors for the development of disorders are the following changes observed in the mother during fetal development:

Toxicosis.
Hypoxia.
Genetic predisposition.

Periventricular edema in a child can be completely cured. In severe cases, the following complications are observed:

Developmental delays.
Hyperactivity.
Epilepsy.
Paralysis.
Hydrocephalus or dropsy.
Vegetative-vascular dystonia.

Dealing with complications is quite difficult, so preventive measures are taken to prevent swelling. All patients at risk during pregnancy are prescribed a course of maintenance therapy and constant monitoring by a doctor. The consequences of cerebral edema in newborns depend on how quickly the disorders were identified and the qualifications of the treating specialist.

How and with what to relieve cerebral edema

It is impossible to relieve swelling at home. The rapid development of disorders necessitates mandatory hospitalization of the patient and the prescription of drug therapy.

Diagnosis of cerebral edema

The choice of diagnostic test depends on the symptomatic manifestations of the disease, as well as the probable cause of the swelling.

The following research methods are traditionally used:

Diagnostic criteria for edema take into account the total volume of the lesion and the localization of the process. This allows you to anticipate possible complications. For example, swelling of the left hemisphere significantly affects the patient’s intellectual abilities, and in severe conditions, paralysis of the right side can be expected.

When examining a patient, a series of tests are performed to identify the catalyst for tissue swelling. Thus, a neurological examination for alcoholism, along with the results of clinical tests, helps to accurately determine the presence of disorders even in the initial stages.

Emergency care for swelling

Brain edema can be cured! But this will require providing timely assistance to the patient and starting treatment for the disease as early as possible. Measures have been developed to help stop tissue swelling until the patient is hospitalized:

The patient must be taken to the hospital immediately. The victim is transported in a horizontal position. To make breathing easier, place a cushion under his feet and turn his head to the side. It is prohibited to place a pillow under your head.

Medicines for swelling

Immediately after the patient’s admission to the hospital, an intensive course of therapy begins, including:

In severe cases, bilateral decompression trepanation is indicated. But, since the consequences after surgery are quite high, especially due to the need to dissect the hard membrane, surgical intervention is extremely rarely resorted to.

If the catalyst that provoked the swelling is a tumor, its removal is indicated.

Treatment of cerebral edema with folk remedies

Traditional therapy methods are used after the main drug treatment. Traditional medicine is against the use of any methods that are not related to official therapy.

Due to the danger of the disease and the high probability of causing unwanted complications or provoking repeated inflammation and swelling of tissues, you can take any herbal decoctions and tinctures only after consultation with your doctor and only during the period of non-exacerbation.

Brain recovery after edema

Modern treatment of cerebral edema is aimed at preventing the recurrence of pathological changes and restoring the maximum possible functional activity of nerve cells and areas of the hemispheres. The prognosis of therapy primarily depends on qualified medical care.

The severity of complications depends on the speed with which treatment was started. The human brain has an amazing feature. The functions of dead cells and areas of brain tissue are taken over by nearby tissues. But this takes time. The patient, after suffering a stroke, will need to relearn how to walk and talk. Over time, there is a partial restoration of lost functions.

Cerebral edema is a dangerous condition that threatens the health and life of the patient. Tissue swelling must be treated exclusively in a hospital. Any methods of self-medication are unacceptable.

The processes of cerebral edema (CED) are one of the most pressing problems of modern medicine. They accompany various neurosurgical, neurological and somatic pathologies. The causes of cerebral edema are multifactorial in nature.

What is it

Cerebral edema (ICD-10 code G 93.6) is a universal nonspecific response of the body to the action of pathogenic factors. It is a companion to critical conditions, in some cases leading to death. The term "edema" is interpreted as excessive accumulation of fluid in the brain tissue. This process is characterized by impaired water-salt metabolism and circulatory disorders in the structures of the brain. It entails an increase in the volume of the contents of the skull and an increase in (ICP).

The space of the cranium consists of brain parenchyma, cerebrospinal fluid and blood in the vessels. If one of the components increases in volume, the others decrease. When the brain edema, the amount of cerebrospinal fluid is reduced and blood vessels are compressed. There may be a reserve inside the skull for changing spatial relationships. In this case, ICP does not go beyond the norm. An increase in brain size, displacement of cerebrospinal fluid and blood increases the likelihood of high blood pressure. This leads to compression of thin-walled veins and a decrease in venous blood in the brain.

Depletion of the described compensatory mechanisms leads to the onset of subcompensation with a noticeable increase in intracranial pressure and occlusion of the CSF flow paths. In the decompensation phase, a slight change in brain volume provokes a pronounced increase in pressure. These processes lead to cessation of cerebrospinal fluid absorption, compression of arterial vessels and the development of cerebral ischemia due to oxygen starvation.

Increased brain volume due to edema may be accompanied by neuronal damage. The degree of their damage and reversibility is proportional to the decrease in cerebral circulation. Up to a certain point, focal neurological deficits are reversible. When the blood flow level decreases to 11 ml per 100 g/min, the death of nerve cells occurs in approximately 8 minutes.

The rate of development of edema after ischemia increases with a significant increase in blood pressure. Its sharp rise can itself provoke OGM without additional interactions.

In children

Predisposition to edematous syndrome and its severity are determined by the characteristics of blood flow in the affected area and the absorbent ability of the tissue. The structure and specificity of its functioning predisposes to the frequent development of cerebral edema.

In a newborn

The fetal head is affected by mechanical forces during labor. The rise and fall of intracranial pressure alternates with contractions and pushing of the woman in labor. Typically, such a head massage does not lead to significant pathological manifestations. But the rate of increase, the force of pressure, and the frequency of oscillations vary over a wide range. Strong exposure can be an irritant, leading to disruption of water balance. In newborns, this is expressed by cerebral edema. It leads to hernial herniation of the brain into the natural openings of the skull.

The level of damage to the fetal head during labor varies. A minor injury can cause cerebral edema, a severe injury can cause acute trauma and damage to the dura mater.

Time passes from the moment of exposure to traumatic force to the development of edema and herniation. Childbirth with a stillborn fetus occurs if it has been in the birth canal throughout this period. If the damage was received at birth, then time passes before dangerous phenomena appear, and the child is born with the signs of a live birth. Medical care for relatively minor injuries can prevent death.

In older children

There are several groups of children with a high risk of developing pathology. First of all, this applies to young children under 2 years of age, especially with neurological diseases. OGM is more often diagnosed in children with a tendency to allergies.

The development of edema is always life-threatening. Compression of the brain stem poses a particular threat. Affecting its important centers ends in death. This process is observed in children over 2 years of age. At an earlier age, due to the plasticity of the sutures and fontanelles of the skull, and an increase in the capacity of the subarachnoid space, conditions exist for natural decompression. With an increase in ICP and an increase in edema up to the 2nd year of life, the head circumference increases, the sutures of the skull diverge, and in infants a large fontanelle opens. This is clearly demonstrated in the figure below.

In adults

In adults, the brain and the tissues that surround it occupy a certain fixed volume, which is limited by the bones of the skull. When analyzing the processes observed in the brain during injury or stroke, the similarity of factors that potentiate damage to brain tissue appears. One of them is the development of edema.

After a stroke

Regardless of the mechanism of stroke development, the patient experiences swelling of the brain tissue due to excessive accumulation of fluid in it. In case of hemorrhagic stroke, patients are diagnosed with complex pathophysiological processes, including the development of edema, microcirculation disorders, and ischemic changes.

At first, after an intracranial hemorrhage, a clot is formed, which becomes denser due to the release of plasma to the periphery of the brain substance.

At the end of the 1st day after the stroke, perifocal vasogenic edema develops. It reaches its peak on days 2-5. The larger the size of the vascular damage, the more pronounced the swelling. The degree of AGM determines the severity of the acute circulatory disorder. Severe swelling dramatically worsens the clinical picture of a stroke. Compressive ischemia of the cortex occurs, which can cause brain death.

Traumatic brain injury and edema

Due to injury, oxygen consumption decreases. Metabolic processes are disrupted due to which the brain does not receive enough energy. A shift in its work leads to swelling. This in turn impedes blood circulation. One of the vicious circles of severe brain damage is formed. In the zone of decreased blood flow, hypoxia occurs. As a result, there is a dysfunction of the brain, which is especially sensitive to oxygen starvation.

Symptoms

The pathological symptoms that arise are caused by dysfunction of all brain structures. The destructive process can lead to focal neurological symptoms. There are 3 clinical syndromes that are most characteristic of AGM:

Thus, AGM has no etiological specificity. The clinic is determined by the localization and severity of the process.

Reasons

Edema syndrome is a reactive condition that develops secondarily as a reaction to any brain damage. The reason is an increase in the permeability of the physiological barrier between the circulatory system and the central nervous system. The blood-brain barrier protects nervous tissue from toxic substances and immune system factors that circulate in the blood and regard brain tissue as foreign. Its damage leads to disruption of mediator exchange and blockade of signal transmission between nerve cells.

Causes of swelling:

infectious diseases (bacterial meningitis, encephalitis, meningoencephalitis);

severe traumatic brain injuries of varying severity;

oncological diseases of the central nervous system;

acute cerebrovascular accident;

surgical interventions;

acute toxic poisoning.

Edema significantly aggravates the course of a particular pathological process. It leads to the development of ischemic and hypoxic disorders, necrosis of cellular structures. The most dangerous consequence of edema is the development of dislocation syndrome with herniation of brain structures into the foramen magnum or under the meninges. As a result, infringement of the cerebellum, parietal and frontal lobes occurs. Long-term consequences may include cognitive impairment and persistent neurological symptoms.

Treatment

Treatment is determined by the characteristics of the pathological process. Depends on the origin and clinical signs of edema. It is a mandatory component of resuscitation measures carried out by a resuscitator in the intensive care unit.

Edema with signs of dislocation primarily requires early artificial ventilation of the lungs with an oxygen-air mixture. First line events:

normalization of venous outflow from the cranial cavity (achieved by positioning the patient with the head end elevated by 30°);

oxygenation;

maintaining normal CO2 levels in the blood;

body temperature control;

sedation (putting the patient into a relaxed state) and analgesia.

If the above measures are ineffective, hyperventilation is indicated for 20-30 minutes. Continued high intracranial pressure is an indication for the administration of hyperosmolar solutions. In the absence of positive dynamics, they proceed to the second-line stage, which includes barbiturate coma, therapeutic hypothermia to 32-34°C, and craniotomy in neurosurgical patients.

Surgery often saves lives. The need for this appears in cases of intracranial hemorrhage of traumatic and non-traumatic origin, occlusive hydrocephalus, and neoplasms. Surgical tactics include removal of the hematoma, abscess, and placement of cerebrospinal fluid drainage.

Consequences

The nature of the swelling is reversible process. The prognosis depends significantly on many factors. Not the least role is played by the patient’s age. In children under 1 year of age, when the skull bones are not fused, dislocation is usually not diagnosed. In older people, OMG often progresses and is aggravated by the development of dislocation.

The course of the pathological process is aggravated by the presence of factors that increase oxygen starvation of the brain. These include pneumonia, anemia, and arterial hypotension.

Cause of death

A feature of OGM is the likelihood of developing fatal injuries: lower and upper. Inferior entrapment occurs due to wedging of the medulla oblongata and cerebellar tonsils into the foramen magnum. Significant compression of the medulla oblongata and the development of hypoxia lead to disruption of the respiratory center. Respiratory arrest and death occur.

Fatal edema develops quickly, within several hours and increases over 1-2 days. It can be a direct cause of death when it is severe. Many unclear cases of rapid death are explained by the occurrence of edema syndrome.

Content

Cerebral edema is a serious pathological process, which is a severe complication of injuries and a consequence of serious diseases. The brain is located in a tight space, limited by the dense bones of the skull, so any enlargement or compression of it poses a serious danger to human life.

What is cerebral edema

A dangerous, critical condition is characterized by rapid progression: a large amount of fluid fills the perivascular intercellular space and cells, the volume of brain tissue increases, intracranial pressure increases, the vessels are compressed, impairing blood circulation in the brain. Brain edema is the body’s reaction to injury, infection, and excessive stress. Medical care must be urgent, qualified, and as effective as possible. Otherwise, the patient's death quickly occurs.

Based on pathogenetic characteristics, swelling of the brain is classified into the following types:

Vasogenic. Appears within 24 hours after a traumatic brain injury in the area of inflammation, hematomas, ischemic areas, tumors, abscesses, and invasive interventions. This perifocal swelling leads to compression of the brain.
Cytotoxic. Develops as a consequence of ischemia, hypoxia (oxygen starvation), intoxication, disruption of astroglial cellular metabolism, encephalopathy, viruses, stroke, cyanide poisoning, combustion products and the breakdown of hemoglobin.
Interstitial. It appears due to the penetration of water through the walls of the ventricles into the brain tissue and accumulates around them.
Osmotic. Occurs as a result of metabolic encephalopathies, improper hemodialysis, polydipsia, drowning in a freshwater environment, hypervolemia.
Hydrostatic. Periventricular edema is a consequence of disorders with increased ventricular pressure. More often occurs in newborns.

Classification by development factors:

postoperative – complications after surgery;
toxic – poisoning with toxic substances;
post-traumatic – characterized by edema and swelling of the brain as a result of injury;
inflammatory – a consequence of inflammatory processes;
tumor - widespread swelling with fatal outcome;
ischemic – a consequence of stroke, hemorrhage;
epileptic;
neuroendocrine;
hypertensive.

Classification by size of swelling:

diffuse – location in one of the hemispheres;
local – location in the focus of fluid accumulation;
generalized – damage to both hemispheres.

Reasons

Increased blood circulation occurs in the brain, so microcirculation disorders with further development of swelling develop easily. Reasons:

Hemorrhage.
Circulatory disorders (ischemic and hemorrhagic stroke).
Malignant tumor of intracranial localization (meningioma, glioblastoma, astrocytoma).
Fractures of the cranial bone accompanied by damage to brain tissue.
Metastases from cancerous tumors of any organ.
Meningitis, meningoencephalitis.
Intracranial hematoma after trauma.
Fracture of the base of the skull.
Contusion, diffuse axonal damage.
Poisoning and severe intoxication with alcohol, neuroparalytic poisons, chemicals and toxic substances.
Surgical interventions.
Anaphylactic reactions due to allergies.

The causes of this disease are multiple and not only intracranial pathological changes. Complications in the form of swelling may be a consequence of any transformations occurring in the microvasculature of tissues and organs under the influence of external and internal pathogenic factors. Pathology in most cases has fatal consequences.

It is impossible to reliably determine what causes the pathology in a particular case, for what reason there was a transition from localized edema to extensive swelling. The development of the disease is influenced by many factors: gender, age, medical history, size, location, condition. Sometimes even a small injury can lead to fulminant edema, and it happens that extensive destruction of areas of the brain is limited to transient or transient edema.

In newborns

The structural features of the brain and cranial cavity in a newborn child are radically different from those in adults, since in children the body is still developing, and the nervous system of adults undergoes age-related changes. Cerebral edema in newborns is characterized by rapid development, since children have imperfect regulation of vascular tone, cerebrospinal fluid dynamics and unstable intracranial pressure.

However, nature thought out everything perfectly, and the design of the skull of newborns includes a fontanelle (soft bridges made of cartilage tissue). This anatomical feature saves the child from swelling and tissue compression at the slightest cry. The causes of swelling can be:

hypoxia of the child inside the womb of a pregnant woman;
birth trauma or difficult childbirth;
congenital defects of the nervous system;
intrauterine infections;
infection during childbirth with meningitis and meningoencephalitis;
congenital abscesses and cancer.

The periventricular type of swelling can be completely cured, but sometimes the consequences can be:

developmental delay;
epilepsy;
hyperactivity;
paralysis;
dropsy or hydrocephalus;
VSD (dystonia).

Symptoms

Clinically, signs of swelling can be divided into cerebral and focal. Symptoms of cerebral edema, their alternation and combination with each other depend on the root cause of the disease. In this regard, gradual and lightning forms of swelling are distinguished. In the first case, there is time to prevent the progression of edema, and in the second, all that remains is the fight for life and slowing down the progression of the pathology for some time.

In adults

For this disease, the following groups of symptoms are distinguished:

focal symptoms;
clinic against the background of intracranial hypertension;
stem symptoms.

Symptoms in adults:

Blurred consciousness. It manifests itself in all types of the disease and varies in severity: from stupor to deep coma. With further increase in edema, the depth of the fainting state increases.
Balance is disturbed when walking.
Headache. It happens due to chronic and increasing acute brain diseases.
Decreased vision.
Drop in blood pressure, drowsiness, weakness.
Nausea accompanied by vomiting.
Convulsions, up to loss of consciousness (the patient bites his tongue).
Breathing disorders.

In children

Young mothers are advised to monitor their children very closely in order to promptly notice any deviations in the baby’s behavior. The presence of a pathological condition in a child is indicated by increased intracranial pressure, neurological changes, and dislocation syndrome of brain structures. The main symptoms of cerebral edema in children are complemented by lethargy, weakness, and headache. Paresis and paralysis may appear or intensify, and the optic nerve swells.

As the pathology progresses, convulsions occur, the functions of the cardiovascular system are disrupted, and symptoms increase. The clinical picture is as follows:

intractable hyperthermia;
headache;
excited state;
"brain" scream;
bulging fontanel;
stiff neck;
coma;
sopor;
acute renal failure;
symptoms of occipital and temporoparietal herniation of the brain: strabismus, anisocoria, disturbance of vital functions (dislocation syndrome of brain structures);
oculomotor crisis with gaze fixation and dilated pupils, tachycardia, increased muscle tone, hyperthermia, pressure instability (midbrain compression syndrome);
mydriasis, vomiting, anisocoria, loss of consciousness (trunk compression syndrome);
bradypnea, bradycardia, dysphagia, vomiting, paresthesia (impaired sensitivity) in the shoulder girdle, stiff neck, respiratory arrest (cerebellar entrapment syndrome).

Treatment

The choice of diagnostic methods and further treatment depends on the symptoms of the disease and the preliminary diagnosis. Used:

examination of the cervical region;
computed tomography of the head;
magnetic resonance imaging;
neurological examination;
blood test to determine the causes and levels of protein in the blood plasma, electrolytes (chlorine, magnesium, sodium, potassium);

If a small swelling can disappear spontaneously in two to four days, then in more complex cases immediate medical intervention is required. Treatment of cerebral edema includes the following methods:

Oxygen therapy - artificial ventilation.
Local hypothermia (the head is covered with ice), lowering body temperature (a now outdated method).
Treatment with drugs that stimulate metabolic processes, glucocorticoids.
Administration of medications intravenously.
Dehydration – taking diuretics in large doses to remove excess fluid.
Ventriculostomy - artificial outflow of cerebrospinal fluid from the cerebral ventricles is carried out by inserting a catheter. As a result, intracranial pressure decreases.
An operation to remove the cause of swelling, restore a damaged vessel, eliminate a tumor, remove a bone fragment of the skull to reduce intracranial pressure.

Consequences

What prognosis do doctors make for cerebral edema? The consequence of the pathology is decompensated changes of a general nature that occur in the body, damage to brain tissue that is incompatible with life. This pathology is very unpredictable; it is impossible to make a precise prognosis. The consequences for the patient may be:

The swelling progresses, transforms into swelling of the brain and results in death.
Complete elimination of pathology without negative consequences for the brain.
Removal of edema and subsequent disability of the patient.

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Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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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 dysfunction of the BBB, 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 has a noticeably different physique (large belly, thin arms/legs), and 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:

headaches;
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:

biochemical blood test;
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 trepanation 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 activities. 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:

frequent headaches;
depression;
sleep pattern disorder;
forgetfulness;
inattention;
increased intracranial pressure, etc.

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