According to abbreviationfinder, the term cerebral edema refers to swelling (edema) of the brain that occurs when the brain increases in volume and pressure. The causes of cerebral edema are varied. If not recognized and treated quickly enough, it can be life-threatening and lead to brain death.
What is cerebral edema?
The brain can swell as a result of injury, illness, or other reasons. Cerebral edema refers to the increase in brain volume and thus increased intracranial pressure, caused by accumulation of fluid in the tissue gaps or brain cells.
This accumulation of fluid is serious in that the brain embedded in the bony skull can hardly expand. Brain swelling is usually difficult to treat and can quickly lead to serious problems, including death. Depending on the cause, swelling can occur in specific locations in the brain or throughout the brain.
Wherever it occurs, the pressure in the skull increases. Swelling puts the brain at risk of not getting enough blood and the oxygen it needs to function, which can lead to brain death. Also, the swelling may block other fluids from draining from the brain, making the swelling worse.
Causes
The causes of cerebral edema are varied. In traumatic brain injury (TBI), a sudden event such as a fall, traffic accident or blow to the head damages the brain. The brain tissue can swell from the injury itself, plus bone splinters injuring blood vessels in the brain.
An ischemic stroke is caused by a blood clot or blockage in or near the brain. As soon as this is no longer supplied with vital blood and oxygen, brain cells begin to die and the brain swells. In the case of a cerebral hemorrhage, in which a blood vessel in the brain bursts, for example due to high blood pressure, swelling occurs due to blood leaking out.
Infections such as meningitis, encephalitis, and toxoplasmosis can also cause brain swelling. Brain tumors can put pressure on areas of the brain, blocking the flow of fluid and causing swelling. Finally, brain swelling can occur at altitudes over 1500 meters ( altitude sickness ).
Symptoms, Ailments & Signs
Depending on the cause and extent of cerebral edema, a number of symptoms can occur. The typical signs and symptoms usually start suddenly and quickly increase in intensity. The main characteristics are severe headache and neck pain, nausea and vomiting as well as dizziness. Breathing stops or becomes irregular in some people.
This can go hand in hand with visual disturbances or even complete loss of vision. In connection with this, paralysis of the eye muscles can occur. Memory loss and memory gaps are also signs of cerebral edema. In many cases, brain tumor symptoms initially resemble the symptoms of first-stage Alzheimer’s disease.
During the course of the disease, difficulties with speaking also arise relatively quickly. The characteristic restlessness increases and seizures or stupor develop. As a result of the increase in intracranial pressure, there is a risk of pinching areas of the brain, which can result in brain damage.
If left untreated, cerebral edema can cause permanent damage and, for example, permanently limit vision or speech or impair motor skills. In the worst case, cerebral edema leads to circulatory arrest with brain death. To avoid this, a doctor should be consulted as soon as the first signs of cerebral edema appear.
Diagnosis & History
The symptoms of cerebral edema vary depending on the cause and extent. They usually start suddenly. The possible signs of cerebral edema include sudden headache, neck pain or stiffness, nausea and vomiting, dizziness, irregular breathing, vision loss or disturbances, memory loss, difficulty speaking, agitation, stupor (rigidity), seizures, impaired consciousness, eye muscle paralysis, and fainting.
As a result of the increase in intracranial pressure, there is a risk that areas of the brain will be pinched, which can lead to damage. Therefore, prompt treatment is of paramount importance.
Cerebral edema can be diagnosed by various examinations. This includes a neurological exam, CT scan and MRI of the head to see the extent and location of the swelling, and blood tests. The intracranial pressure itself can be measured using a catheter or probe.
Complications
Cerebral edema itself is a complication and can develop as a result of surgery, injury, or disease. Due to the increasing pressure in the brain, brain substance can be displaced. This affects vital structures, so that in the worst case cerebral edema leads to circulatory arrest and brain death.
Even if this can be prevented, the course of the process causes permanent damage as brain cells die from the lack of oxygen. The decisive factor here is the location of the brain edema and which regions are affected. Perception as well as the ability to speak or motor skills can be impaired. Breathing problems are also possible.
In any case, it is necessary for cerebral edema to be treated as soon as possible. This is the only way to avoid brain damage and save the affected person from brain death. Since medication is administered to promote elimination, hypersensitivity can lead to side effects.
While medication and special positioning can often be sufficient to reduce swelling and reduce the load on the brain, in certain cases surgical intervention is necessary. Part of the skull bone is removed and the brain is exposed. Of course, such interventions also harbor complications, but they are often decisive for the survival of the person concerned.
When should you go to the doctor?
If symptoms such as headache, dizziness and high blood pressure occur at the same time, cerebral edema may be the cause. A doctor should be consulted if symptoms persist for more than a week. If the symptoms increase in intensity and noticeably impair well-being, medical advice must be sought immediately. In the case of complications such as impaired consciousness or repeated vomiting, it is best to go to a hospital. Cerebral edema occurs primarily in connection with craniocerebral trauma or brain tumors.
Edema also occurs again and again after infections such as encephalitis or meningitis. Anyone who belongs to these risk groups should consult their doctor promptly if they experience the symptoms mentioned. Children, the elderly and pregnant women should also see a doctor if they have non-specific symptoms that indicate a serious illness. If you lose consciousness or have a seizure, you need emergency medical attention. The first aiders must also provide first aid measures and bring the person concerned into the stable side position. A longer hospital stay is then usually indicated, during which the symptoms are clarified and any cerebral edema is surgically removed.
Treatment & Therapy
Slight cerebral edema, caused, for example, by moderate altitude sickness or a slight concussion, often subsides within a few days. In most cases, however, cerebral edema must be treated immediately and monitored in intensive care.
It is important to ensure that the brain is getting enough blood and oxygen, that swelling is reduced and that the causes of cerebral edema are treated. Treatment can include a variety of medical and surgical treatments.
Patients are positioned with their upper body elevated and their heads straight. Oxygen is supplied via a breathing mask and blood pressure is kept low with medication or intravenous therapy. Sedation may be useful to reduce blood flow and thus intracranial pressure. Hypothermia treatment, i.e. lowering the body temperature, protects affected areas of the brain by lowering the brain’s energy requirements. With diuretics such as high-dose corticosteroids, fluid excretion via the kidneys is promoted and thus cerebral edema is reduced.
Possible surgical interventions include ventriculostomy, in which fluid (liquor) is drained through a small opening in the skull and the cerebral edema is relieved. A decompressive craniectomy is also effective, in which the bony skullcap over the swelling area is surgically temporarily removed in order to give the cerebral edema more space until it has subsided. In the case of a tumor, this is surgically removed as far as possible.
Outlook & Forecast
The prognosis for a patient with cerebral edema essentially depends on two factors: the trigger of the cerebral edema is decisive on the one hand, and the severity of the symptoms on the other. The trigger depends on whether the cause is permanently reversible. For example, if it is a brain tumor that is very malignant, the prospect of a cure is unfavorable. Because even if the cerebral edema should temporarily recede due to certain medications, the swelling often occurs again due to the growth of the tumor and destroys other areas of the brain.
The severity of the edema is also an important criterion for the patient’s prognosis. Because the more edema has already spread in important areas of the brain, the more areas of the brain are destroyed and their functions are restricted or completely abolished. This happens because the intracranial pressure increases due to the edema, since it spreads through the natural limitation of the solid cranial capsule. Therefore, the prognosis in severe edema formation is often unfavorable.
This is especially the case if the time between the occurrence of the damaging edema and the initiation of necessary treatment measures is very long. If, for example in the case of accidents or cerebral hemorrhage, there is an additional source of bleeding in addition to cerebral edema, this further worsens the prognosis.
Prevention
Prevention is problematic in the case of cerebral edema, due to the causes that usually occur suddenly and unpredictably. Swelling can be reduced, but often not prevented, by elevating the upper body, treating blood pressure and blood sugar, and administering water-repellent medication. If conservative treatment is ineffective, surgical opening of the skull may be necessary.
Aftercare
The follow-up measures that need to be taken after cerebral edema depend on the cause and consequences of the swelling and the type of treatment. If an injury is the cause, it will be checked as part of the follow-up checks. As long as no complications occur or the injury has completely healed, the cause does not have to be included in the follow-up care.
If the cerebral edema is due to poisoning, further blood tests may need to be carried out to ensure that the toxin has been completely eliminated. The aftercare of cerebral edema is carried out by a neurologist. The doctor will do a CT scan and also do a physical exam. In the case of permanent brain damage, one of the things that counts is relearning lost skills for aftercare.
The necessary therapeutic measures depend on the type and severity of the brain damage. In principle, the patient must visit the doctor regularly so that the health progress can be checked. In addition, the medication must be regularly adapted to the symptoms. Typically used drugs with the active ingredients clopidogrel or edoxaban reduce any pain, prevent blood clots and reduce the risk of a heart attack after brain swelling. The responsible neurologist must decide which measures are sensible in detail.
You can do that yourself
Cerebral edema cannot be treated as part of self-help measures. Those affected are usually always dependent on medical treatment and, in many cases, on surgical intervention.
In some cases, the symptoms can be relieved with the help of diuretics. However, this is only a temporary treatment. If the person concerned has suffered an accident in which the head was also damaged, the brain should always be examined. Even after successful treatment, regular medical examinations are necessary. If the person concerned loses consciousness due to cerebral edema, an ambulance must be called immediately or the nearest hospital must be visited. Early detection and treatment of the disease has a very positive effect on its further course. In most cases, the symptoms disappear completely after the treatment, so that further measures are no longer necessary.
If the symptoms of cerebral edema occur at a high altitude, you must leave this altitude immediately. This can prevent further discomfort or bleeding. In the event of a stroke, the patient is often dependent on the help of other people in their everyday life. The help of friends and family proves to be particularly helpful.