Cerebral edema: what is it, causes, symptoms, treatment
The content of the article:
- Cerebral edema - what is it?
- Causes of cerebral edema
- Classification
- Symptoms of cerebral edema
- Diagnostics
- Cerebral edema treatment
- Complications
- Consequences and forecast
- Prevention
- Video
Cerebral edema (OGM, cerebral edema) is a pathological condition associated with excessive accumulation of fluid in the brain tissues. Clinically, it is manifested by the syndrome of increased intracranial pressure. Doctors of different specializations face OGM in practice:
- neurosurgeons;
- neurologists;
- neonatologists;
- traumatologists;
- toxicologists;
- oncologists.
Cerebral edema - what is it?
Cerebral edema is not an independent disease, but a clinical syndrome that always develops secondarily in response to any damage to the brain tissue.
Cerebral edema is a life-threatening condition
The main triggering factor in the pathogenesis of OGM development is microcirculation disorders. Initially, they are localized in the area of damage to cerebral tissues and cause the development of perifocal (limited) edema. With severe brain damage, late initiation of treatment, microcirculation disorders take on a total character. This is accompanied by an increase in hydrostatic intravascular pressure and an expansion of the blood vessels in the brain, which, in turn, causes the blood plasma to sweat into the brain tissue. As a result, the development of generalized OGM occurs.
Swelling of cerebral tissues causes an increase in their volume, and since they are in the closed space of the cranium, it also increases intracranial pressure. The blood vessels are compressed by the cerebral tissue, which further enhances microcirculatory disorders and is the cause of oxygen starvation of nerve cells, their mass death.
Causes of cerebral edema
The most common causes of OGM are:
- severe craniocerebral trauma (fracture of the skull base, contusion of the brain, subdural or intracerebral hematoma;
- ischemic or hemorrhagic stroke;
- hemorrhage in the ventricles or subarachnoid space;
- brain tumors (primary and metastatic);
- some infectious and inflammatory diseases (meningitis, encephalitis);
- subdural empyema.
Much less often, the occurrence of OGM is due to:
- severe systemic allergic reactions (anaphylactic shock, angioedema);
- anasarca, which has arisen against the background of renal or heart failure;
- acute infectious diseases (mumps, measles, influenza, scarlet fever, toxoplasmosis);
- endogenous intoxication (hepatic or renal failure, severe diabetes mellitus);
- acute poisoning with medicines or poisons.
In elderly people who abuse alcohol, there is an increase in the permeability of the vascular walls, which can lead to the development of cerebral edema.
The following factors are the causes of OGM in newborns:
- severe course of gestosis;
- entanglement with the umbilical cord;
- intracranial birth injury;
- protracted labor.
Classification
Depending on the causes and pathological mechanism of development, several types of OGM are distinguished:
| A type | Cause and mechanism of development |
| Vasogenic | Most common. It occurs as a result of damage to the blood-brain barrier and the release of plasma into the extracellular space of the white matter. Develops around areas of inflammation, tumors, abscesses, trauma, ischemia |
| Cytotoxic | The main causes are intoxication and ischemia, which cause intracellular hydration. Usually localized in gray matter and diffusely spread |
| Osmotic |
The cause of its occurrence is a decrease in blood osmolarity due to inadequate hemodialysis, metabolic disorders, drowning, polydipsia, hypervolemia |
| Interstitial | Occurs in patients with hydrocephalus as a result of the sweating of cerebrospinal fluid into the nervous tissue around the ventricles |
Symptoms of cerebral edema
The main sign of OGM is impaired consciousness of varying severity, ranging from mild stunning and ending with deep coma.
As the edema grows, the depth of the disturbance of consciousness also increases. At the very beginning of the development of pathology, convulsions are possible. In the future, muscle atony develops.
During the examination, the patient has meningeal symptoms.
With preserved consciousness, the patient complains of severe headache, accompanied by excruciating nausea, repeated vomiting, which does not bring relief.
Other symptoms of OGM in adults and children are:
- hallucinations;
- dysarthria;
- discoordination of movements;
- visual disturbances;
- motor restlessness.
With excessive OGM and wedging of the brain stem into the foramen magnum, the patient develops:
- unstable pulse;
- pronounced arterial hypotension;
- hyperthermia (increase in body temperature up to 40 ° C and above);
- paradoxical breathing (alternating shallow and deep breaths, with different time intervals between them).
Diagnostics
It is possible to assume that a patient has an OGM based on the following signs:
- growing oppression of consciousness;
- progressive deterioration in general condition;
- the presence of meningeal symptoms.
To confirm the diagnosis, a computed or magnetic resonance imaging of the brain is shown.
Diagnostic lumbar puncture is performed in exceptional cases and with great care, as it can provoke dislocation of brain structures and compression of the trunk.
To identify the possible cause of OGM, carry out:
- assessment of neurological status;
- analysis of CT and MRI data;
- clinical and biochemical blood tests;
- collection of anamnestic data (if possible).
In severe cases, diagnostic measures are carried out simultaneously with the provision of first aid.
Cerebral edema treatment
NN Burdenko, the founder of the Soviet school of neurosurgery, wrote: “Those who have mastered the art of treating and preventing cerebral edema have the key to the life and death of the patient”.
Patients with OGM are subject to emergency hospitalization in the intensive care unit. Treatment includes the following areas:
- Maintaining optimal blood pressure levels. It is desirable that the systolic pressure be at least 160 mm Hg. Art.
- Timely tracheal intubation and transfer of the patient to artificial respiration. The indication for intubation is an increase in the intensity of respiratory failure. Mechanical ventilation is carried out in the hyperventilation mode, which increases the partial pressure of oxygen in the blood. Hyperoxygenation contributes to the narrowing of cerebral vessels and a decrease in their permeability.
- Facilitation of venous outflow. The patient is placed on a bed with a raised head end, with the cervical spine extended as much as possible. Improving venous outflow contributes to a gradual decrease in intracranial pressure.
- Dehydration therapy. It is aimed at removing excess fluid from the cerebral tissues. It is carried out by intravenous administration of osmotic diuretics, colloidal solutions, loop diuretics. If necessary, to potentiate the diuretic effect of diuretics and supply neurons with nutrients, the doctor may prescribe intravenous administration of hypertonic glucose solution, 25% magnesium sulfate solution.
- Glucocorticoid hormones. They are effective in the case of perifocal cerebral edema caused by the development of a tumor process. They are ineffective in case of OGM associated with traumatic brain injury.
- Infusion therapy. Aimed at detoxification, elimination of violations of the water-electrolyte and colloid-osmotic balance.
- Antihistamines. They reduce the permeability of the vascular walls, prevent the occurrence of allergic reactions, and are also used to stop them.
- Means that improve cerebral circulation. They improve blood flow in the microvasculature, thereby eliminating ischemia and hypoxia of the nervous tissue.
- Means that regulate the metabolic process and nootropics. Improves metabolic processes in damaged neurons.
- Symptomatic therapy. Includes the appointment of antiemetic, anticonvulsant, pain relievers.
If OGM is caused by an infectious and inflammatory process, antiviral or antibacterial drugs are included in the complex therapy. Surgical treatment is carried out to remove tumors, intracranial hematomas, and areas of brain crush. With hydrocephalus, bypass surgery is performed. Surgical intervention is usually performed after stabilization of the patient's condition.
In some cases, cerebral edema requires surgery
Complications
With a significant increase in intracranial pressure, dislocation (displacement) of brain structures and infringement of its trunk in the foramen magnum can be observed. This leads to severe damage to the respiratory, vasomotor and thermoregulatory centers, which can be fatal against the background of increasing acute heart and respiratory failure, hyperthermia.
Consequences and forecast
At the initial stage of development, OGM is a reversible state, but as the pathological process progresses, neurons die and myelin fibers are destroyed, which leads to irreversible damage to brain structures.
With an early start of treatment for OGM of toxic genesis in young and initially healthy patients, full recovery of brain functions can be expected. In all other cases, residual effects of varying severity will be noted:
- persistent headaches;
- distraction;
- forgetfulness;
- depression;
- sleep disorders;
- increased intracranial pressure;
- disorders of motor and cognitive functions;
- mental disorders.
Prevention
Primary prevention measures of cerebral edema are aimed at preventing the underlying causes of its development. They can include:
- prevention of industrial, road transport and domestic injuries;
- timely detection and active treatment of arterial hypertension and atherosclerosis, which are the main causes of stroke;
- timely therapy of infectious and inflammatory diseases (encephalitis, meningitis).
If the patient has a pathology, against which the development of cerebral edema is possible, then he must be given preventive treatment aimed at preventing the swelling of the brain substance. It can include:
- maintenance of normal oncotic plasma pressure (intravenous administration of hypertonic solutions, albumin, fresh frozen plasma);
- appointment with high intracranial pressure of diuretics;
- artificial hypothermia - allows you to reduce the energy requirements of brain cells and thereby prevents their mass death;
- the use of drugs that improve the tone of cerebral vessels and metabolic processes in brain tissues.
Video
We offer for viewing a video on the topic of the article.
Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
