From the Guidelines
Diffuse cerebral edema is primarily caused by ischemic stroke, leading to cytotoxic edema due to loss of function of membrane transporters, causing sodium and water influx into the necrotic or ischemic cell, as well as vasogenic edema from blood-brain barrier disruption 1. The main causes of diffuse cerebral edema include:
- Ischemic stroke, where oxygen deprivation leads to cellular swelling
- Traumatic brain injury, which damages brain cells and disrupts the blood-brain barrier
- Hemorrhagic stroke, causing inflammatory responses and increased intracranial pressure
- Infections like meningitis and encephalitis that trigger inflammatory cascades
- Hypoxic brain injury from cardiac arrest or drowning
- Metabolic disorders such as diabetic ketoacidosis, hyponatremia, and liver failure
- Toxic exposures including carbon monoxide poisoning and certain medications
- Brain tumors that obstruct CSF flow
- Hydrocephalus from CSF circulation disruption
- High-altitude cerebral edema These conditions cause edema through various mechanisms including cytotoxic processes, vasogenic processes, interstitial processes, and osmotic processes. According to the American Heart Association/American Stroke Association guidelines, measures to lessen the risk of edema and close monitoring of the patient for signs of neurological worsening during the first days after stroke are recommended (Class I; Level of Evidence A) 1. Treatment of diffuse cerebral edema often includes measures to reduce intracranial pressure, such as osmotic diuretics like mannitol or hypertonic saline, head elevation to 30 degrees, controlled hyperventilation in severe cases, and sometimes surgical decompression for refractory cases 1.
From the Research
Causes of Diffuse Cerebral Edema
- Cerebral trauma 2
- Massive cerebral infarction 2
- Hemorrhages 2
- Abscess 2
- Tumor 2
- Allergy 2
- Sepsis 2
- Hypoxia 2
- Toxic or metabolic factors 2
Types of Cerebral Edema
- Vasogenic cerebral edema: resulting from an increased permeability of the endothelium of cerebral capillaries to albumin and other plasma proteins 2
- Cytotoxic cerebral edema: resulting from the exhaustion of the energy potential of cell membranes without damage to the barrier 2
- Hydrostatic cerebral edema: resulting from disturbance of the autoregulation of cerebral blood circulation 2
- Osmotic cerebral edema: resulting from dilution of blood 2
- Interstitial cerebral edema: resulting from acute hydrocephaly 2
- Ischemic cerebral edema: also differentiated by some authors 2
Pathophysiology of Cerebral Edema
- Complex and remains incompletely understood 3
- Starling forces are physical drivers of edema based on differences in intravascular vs extracellular hydrostatic and oncotic pressures 3
- Molecular mechanisms and networks contributing to cerebral edema after traumatic brain injury are still being elucidated 3
- Regulation of blood-brain barrier permeability has become a focus of recent research seeking to manage brain edema 4
- Aquaporins, matrix metalloproteinases and vasoactive inflammatory agents have emerged as potential mediators of cerebral edema following traumatic brain injury 4