When cerebral edema , according to Reichardt (1904) a form of brain swelling (cerebral increase in volume), it is caused by damage to the blood-brain barrier or the blood-cerebrospinal fluid barrier to edema , so to fluid retention in the brain .
The cerebral edema is a complication of pathological processes (e.g. tumors , inflammation , poisoning , vascular processes) or disruption of the water-electrolyte balance of the brain that occurs after injuries , operations and after successfully treated cardiac arrest . The fluid accumulation occurs predominantly intracellularly in the astrocytes continue.
Cerebral edema can also result from the influence of high altitude and the associated reduced oxygen partial pressure in the breath, especially when climbing at high altitude . See also high altitude brain edema (HACE).
In quantitative disturbances of consciousness and general signs of increased intracranial pressure lends itself to the history survey and neurological examination, a ophthalmoscopy at which a positive result in papilledema would show. The imaging examination of the inside of the skull using computed tomography or magnetic resonance imaging provides security .
The vasogenic form is based on a permeability disorder of the blood-brain barrier or an increased permeability of the capillary vessels , which leads to the influx of fluid into the interstitium. The underlying diseases here are head trauma , infections, abscesses and brain tumors .
In cytotoxic brain edema, the intracellular space of the brain increases as a result of a partial local breakdown of the sodium-potassium pump , as sodium passes into the cells and draws chlorine ions and water with it. Causes are global or local oxygen deficiency , liver failure and hypotonic hyperhydration as well as the late phase of a traumatic brain injury.
Since the brain has little opportunity to expand due to the bony skull surrounding it, cerebral edema is usually a serious disease, especially since the swelling brain can also compress the sinuses , which ensure the blood flow from the brain. The intracranial pressure increases, which leads to a decrease in the cerebral perfusion pressure and thus the cerebral blood flow. A ischemia with a result of infarction and brain damage is a continuing through to brain death may result.
- The standard is an upper body elevation of 15–30 °
- Pressure relief by draining CSF through an external ventricular drainage
- Trepanation / craniectomy to give the brain additional space
- u. U. osmotically effective diuretic , e.g. E.g .: mannitol , glycerin , to create an osmotic gradient between plasma and tissue and thereby drain the brain.
- short-term hyperventilation in the event of an acute critical increase in intracranial pressure
- Use of TRIS (buffering intracellular acidosis ) or barbiturates (lowering the cerebral metabolism)
- Mild therapeutic hypothermia
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- German Society for Neurology: Guideline on intracranial pressure ( memento of the original from September 23, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 2012, p. 10.
- German Society for Neurology: Guideline on intracranial pressure ( Memento of the original from September 23, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 2012, p. 7.