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20-September-2008 10:08:30 - Cerebral edema Cerebral edema Classification and external resources ICD-10 G93.6 ICD-9 348.5 DiseasesDB 2227 MeSH D001929 Cerebral edema cerebral oedema in British English is an excess accumulation of water in the intracellular and/or extracellular spaces of the brain. Contents 1 Types 1.1 Vasogenic cerebral edema 1.2 Cytotoxic cerebral edema 1.3 Osmotic edema 1.4 Hydrostatic edema 1.5 Interstitial cerebral edema 1.6 High Altitude Cerebral Edema 2 Treatment 3 References 4 External links Types Vasogenic cerebral edema Due to a breakdown of tight endothelial junctions which make up the blood-brain barrier BBB. This allows normally excluded intravascular proteins and fluid to penetrate into cerebral parenchymal extracellular space. Once plasma constituents cross the BBB, the edema spreads; this may be quite fast and widespread. As water enters white matter it moves extracellularly along fiber tracts and can also affect the gray matter. This type of edema is seen in response to trauma, tumors, focal inflammation, late stages of cerebral ischemia and hypertensive encephalopathy. Some of the mechanisms contributing to BBB dysfunction are: physical disruption by arterial hypertension or trauma, tumor-facilitated release of vasoactive and endothelial destructive compounds e.g. arachidonic acid, excitatory neurotransmitters, eicosanoids, bradykinin, histamine and free radicals. Cytotoxic cerebral edema In this type of edema the BBB remains intact. This edema is due to the derangement in cellular metabolism resulting in inadequate functioning of the sodium and potassium pump in the glial cell membrane. As a result there is cellular retention of sodium and water. There are swollen astrocytes in gray and white matter. Cytoxotic edema is seen with various intoxications dinitrophenol, triethyltin, hexachlorophene, isoniazid, in Reye's syndrome, severe hypothermia, early ischemia, encephalopathy, early stroke or hypoxia, cardiac arrest, pseudotumor cerebri, and cerebral toxins. Osmotic edema Normally cerebral-spinal fluid CSF and extracellular fluid ECF osmolality of the brain is slightly greater than that of plasma. When plasma is diluted by excessive water intake or hyponatremia, syndrome of inappropriate antidiuretic hormone secretion SIADH, hemodialysis, or rapid reduction of blood glucose in hyperosmolar hyperglycemic state HHS, formerly hyperosmolar non-ketotic acidosis HONK, the brain osmolality will then exceed the serum osmolality creating an abnormal pressure gradient down which water will flow into the brain causing edema. It affects the brain so severely that the victim feels like drowning until he/she dies the slow painful death. Hydrostatic edema This form of cerebral edema is seen in acute, malignant hypertension below the upper left cordial. It is thought to result from direct transmission of pressure to cerebral capillary with transudation of fluid into the ECF. Interstitial cerebral edema Occurs in obstructive hydrocephalus. This form of edema is due to rupture of CSF-brain barrier: permits CSF to penetrate brain and spread in the extracellular space of white matter. Differentiated from vasogenic edema in that fluid contains almost no protein High Altitude Cerebral Edema High altitude cerebral edema or HACE is a severe usually fatal form of altitude sickness. HACE is the result of swelling of brain tissue from fluid leakage. Symptoms can include headache, loss of coordination ataxia, weakness, and decreasing levels of consciousness including disorientation, loss of memory, hallucinations, psychotic behavior, and coma. It generally occurs after a week or more at high altitude. Severe instances can lead to death if not treated quickly. Immediate descent is a necessary life-saving measure 2,000 - 4,000 feet. There are some medications e.g. dexamethasone that may be prescribed for treatment in the field, but these require proper medical training in their use. Anyone suffering from HACE must be evacuated to a medical facility for proper follow-up treatment. A gamow bag can sometimes be used to stabilize the sufferer before transport or descending. Climbers may also suffer high altitude pulmonary edema HAPE, which affects the lungs. While not as life threatening as HACE in the initial stages, failure to descend to lower altitudes or receive medical treatment can also lead to death. Treatment Treatment approaches can include diuretics and corticosteroids.1 References ^ Raslan A, Bhardwaj A 2007. Medical management of cerebral edema. Neurosurgical focus 22 5: E12. doi:10.3171/foc.2007.22.5.13. PMID 17613230. External links v d e Pathology of the nervous system, primarily CNS G00-G47, 320-349 Inflammatory Meningitis Arachnoiditis - Encephalitis - Myelitis - Encephalomyelitis Acute disseminated - Tropical spastic paraparesis - Cavernous sinus thrombosis Systemic atrophies Huntington's disease - Spinocerebellar ataxia Friedreich's ataxia, Ataxia telangiectasia, Herary spastic paraplegia - Spinal muscular atrophy: Werdnig-Hoffman - Kugelberg-Welander - Fazio-Londe - MND ALS, PMA, PBP, PP, PLS Extrapyramidal and movement disorders Parkinson's disease - Neuroleptic malignant syndrome - Postencephalitic parkinsonism - Pantothenate kinase-associated neurodegeneration - Progressive supranuclear palsy - Striatonigral degeneration - Dystonia/Dyskinesia Spasmodic torticollis, Meige's, Blepharospasm - Essential tremor - Myoclonus - Lafora - Chorea Choreoathetosis - Restless legs - Stiff person Other degenerative/ demyelinating diseases dementia: Alzheimer's - Pick's - Dementia with Lewy bodies - Frontotemporal lobar degeneration mitochondrial disease: Leigh's demyelinating: Multiple sclerosis - Devic's - Central pontine myelinolysis - Transverse myelitis - Marchiafava-Bignami disease - CAMFAK syndrome - Alpers' Seizure/epilepsy Focal - Generalised - Status epilepticus - Myoclonic epilepsy Headache Migraine Familial hemiplegic - Cluster - Vascular - Tension Vascular Transient ischemic attack Amaurosis fugax, Transient global amnesia Cerebrovascular disease MCA, ACA, PCA, Foville's, Millard-Gubler, Lateral medullary, Weber's, Lacunar stroke Sleep disorders Insomnia - Hypersomnia - Sleep apnea Obstructive, Ondine's curse - Narcolepsy - Cataplexy - Kleine-Levin - Circadian rhythm sleep - Delayed sleep phase - Advanced sleep phase Intracranial hypertension Hydrocephalus Normal pressure - Idiopathic intracranial hypertension Other encephalopathy Brain herniation - Cerebral edema - Reye's Other spinal cord disease Syringomyelia - Syringobulbia - Morvan's syndrome - Spinal cord compression v d e Pathology: hemodynamics Infarction general: Anemic infarct - Hemorrhagic infarct regional: Myocardial infarction Hemorrhage general: Ecchymosis - Hematoma - Petechia - Purpura - Hemarthrosis regional: head Epistaxis, Hemoptysis, Intracranial hemorrhage, Hyphema - torso Hemothorax, Hemopericardium - abdomen Gastrointestinal bleeding, Haemobilia, Hemoperitoneum, Hematocele, Hematosalpinx Edema general: Anasarca - Lymphedema - Exudate/Transudate regional: Cerebral edema - Pulmonary edema - Hydrothorax - Ascites/hydroperitoneum - Hydrosalpinx Ischemia Brain ischemia - Ischaemic heart disease Thrombus/thrombosis Renal vein thrombosis Retrieved from http://en..org/wiki/Cerebral_edema Categories: Cerebrum | Mountaineering Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Italiano Nederlands Polski Suomi This page was last modified on 4 August 2008, at 20:52
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