Management of Brain Edema in Head Injury
Strictly speaking, brain edema represents an increase in the bulk of the brain that has been produced by an increase in its tissue water content. In the context of the management of severely head-injured patients in the intensive care unit, however, the term brain edema is commonly used in a wider context, to include all conditions of increased brain volume or brain swelling frequently, but not always, associated with raised intracranial pressure (ICP). There are many potential causes of raised ICP after head injury. These include formation of true brain edema, development of an intracranial mass lesion (such as a subdural hematoma, which may also be associated with edema formation), acute swelling of the brain due to an increase in cerebral blood volume, and accumulation of cerebrospinal fluid in the form of acute hydrocephalus. For optimal management of the severely head-injured patient and effective treatment of raised ICP and its adverse sequelae, it is important to be aware of the several possible causes of intracranial hypertension and different mechanisms by which water content may increase and ICP rise. Wherever possible, therapy should be chosen that is appropriate to the underlying pathophysiological mechanism. In the comatose head-injury patient, the therapeutic “window” is narrow and time does not permit a random sequence of empirically applied therapies for reduction of ICP and resolution of brain edema.
KeywordsHead Injury Brain Edema Intracranial Hypertension Cerebral Perfusion Pressure Cerebral Blood Volume
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