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Experimental Cerebral Effects of Intravenous Fluid Therapy

  • M. H. Zornow
Conference paper

Summary

Intracranial hypertension resulting from cerebral edema is a major cause of morbidity and mortality in patients with traumatic brain injury. In the noninjured brain, water movement between the vasculature and the brain parenchyma is determined primarily by osmolar gradients. Administration of hypertonic solutions such as mannitol or concentrated saline solutions produces a brain-to-plasma osmotic gradient favoring the movement of water out of the brain parenchyma and into the vessels. This osmotic gradient can be maintained due to the high reflection coefficients for sodium ions, chloride ions, and mannitol, which effectively prevent them from crossing the blood-brain barrier.

Cryogenic lesions have long been used to model the pathophysiology of traumatic brain injury. These lesions are highly reproducible and it is a simple matter to vary their intensity depending on the goals of the studies. Many of the histologic features of traumatic brain contusions are found in cryogenic lesions, including cytolysis of neurons, petechial hemorrhages, an inflammatory response as evidenced by the accumulation of monocytes and leukocytes, and the appearance of edematous tissue at the periphery of the lesion. Using cryogenic lesions, various investigators have examined the ability of hypertonic solutions to decrease brain edema and control intracranial hypertension. Although most studies have concluded that hypertonic saline is superior to isotonic solutions, there is little or no evidence that it is superior to more conventional therapy with an equiosmolar dose of mannitol.

One of the most promising new techniques for study of cerebral edema is the use of magnetic resonance imaging (MRI). This technology should allow the serial noninvasive measurement of regional brain water content. Additional studies are required to correlate MRI findings with more direct measures of brain water content.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1997

Authors and Affiliations

  • M. H. Zornow

There are no affiliations available

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