Swelling of the brain to drink urine. What is the danger of cerebral edema and what is the prognosis for life? Methods of surgical intervention in parts of the brain

Cerebral edema is a serious disorder and poses a serious threat to life. Let's look at this disease in detail.

Edema is a pathological process that involves the occurrence of diffuse saturation of brain tissue with fluid contained in the vascular space.

The onset of the process is due to the appearance of some irritant, such as infection, intoxication, or. This leads to the formation of excess fluid in the brain cells, resulting in swelling.

If a patient with cerebral edema is not provided with timely medical care, this most often leads to serious consequences, often to death.

This process is the human body’s response to excessive stress, or infectious diseases.

The development of the process occurs quite quickly; excess fluid accumulates in the cells and in the intercellular space, as a result of which the size of the brain begins to increase. This leads to increased performance, poor blood circulation and death of brain cells.

With the development of this pathological process, it is difficult to give a prognosis; it all depends on the timeliness of care medical care. If help was provided immediately, this significantly reduces the risk of severe consequences.

Factors are provocateurs

Many factors can lead to the development of cerebral edema; the most common causes of this condition are:

In addition to the above, swelling can also occur in a completely healthy person, for example, when climbing to a high altitude (at least 1500 m) above sea level. In such situations, a sharp decrease in blood pressure occurs, which can also lead to the development of edema.

First signs

The development of cerebral edema occurs in stages, at the beginning of this process the following symptoms can be observed:

As the process progresses, more serious symptoms and disorders appear.

Features of the clinical picture

Symptoms depend on how long the disease lasts and the location of the lesions in the brain structures. There are three groups of symptoms.

Neurological symptoms caused by swelling in the cerebral cortex with penetration into the subcortical region. These include:

In cases where cerebral edema causes sudden swelling, it has the following manifestations:

• the appearance of nausea and vomiting;
• frequent change from a depressed state to psychomotor agitation;
• headache;
• eye movement disorder;
• the appearance of seizures.

Cramps can occur in the facial muscles and limbs, and can also be longer lasting, characterized by an unnatural body position.

With progressive edema, which causes displacement and infringement of brain structures, the following symptoms appear:

• increase in body temperature to 40 degrees or more, which cannot be reduced;
• the reaction of the pupils to light is weak or absent;
• one-sided (paralysis) and convulsions appear;
• heart rhythm is disturbed;
• there are no pain and tendon reflexes;
• coma.

If the patient is on artificial ventilation lungs, then the frequency and depth of breathing first increase, after which respiratory and cardiac activity ceases.

First aid for suspected swelling

If cerebral edema occurs important role plays a role in the timely and correct provision of medical care. The patient is subject to immediate hospitalization, where he will be provided the following measures first aid:

• ensuring lung patency by supplying oxygen through a mask or nasal catheters;
• administration of Mannitol intravenously 3-4 times a day;
• after Mannitol, Furosemide is administered;
• at high rates Magnesium sulfate is used for intracranial pressure.

In cases where swelling is accompanied by convulsions and breathing problems, it is advisable to use:

To stimulate brain function, it is possible to use Trental intravenously, and after 2-3 days Piracetam is prescribed.

Establishing diagnosis

Neurologists suspect cerebral edema can be caused by a person’s constantly deteriorating condition, accompanied by disturbances of consciousness and the presence of cerebral edema.

The preliminary diagnosis can be confirmed or refuted using CT or CT scans, as well as by assessing the neurological status, blood tests and research and identifying the possible causes of the condition.

Due to the fact that cerebral edema is a rapidly developing process, primary diagnosis should be carried out as soon as possible. short time, in this case it is better to place the patient in a hospital.

Complex of therapeutic measures

In rare cases, the disease goes away within a few days, for example, if the swelling occurs due to a lung. Other cases require immediate medical attention.

The main goal of treatment is normalization metabolic processes brain cells, resulting in a decrease in swelling. Treatment consists of a combination of medication and surgery to treat the problem.

In such cases, it is necessary to ensure sufficient oxygen supply to the brain; for this purpose, oxygen is artificially administered through inhalers or other devices. The result of these measures is the saturation of the blood and brain with oxygen, which contributes to a speedy recovery.

In order to maintain performance and fight infections, methods of administering medications through an IV are used.

If cerebral edema is accompanied by an increase in body temperature, measures must be taken to reduce it. This helps reduce swelling.

The choice of medications in this case depends on the characteristics of the patient’s condition, symptoms and causes of edema.

Particularly severe cases require the following measures:

• removal of excess fluid in the ventricles of the brain using a catheter, which reduces intracranial pressure;
• restoration of a damaged blood vessel or removal of tumors if they are detected;
• removal of fragments of cranial bone to reduce intracranial pressure.

Cerebral edema is an unpredictable pathology, so there is no guarantee that the treatment will be effective.

Very dangerous and unpredictable

Cerebral edema is a critical condition and often ends in death. Damage to brain tissue caused by this condition leads to serious changes in the condition of the body or is completely incompatible with life.

There are only three options for the development of events:

1. No consequences and full recovery sick. This happens extremely rarely, in cases where edema occurs in a young and healthy person, for example, due to alcohol or other poisoning. If medical assistance is provided in a timely manner, the violation will not lead to any serious consequences.
2. Relief of edema with partial recovery and disability. This option occurs much more often when the cause of edema is meningitis, encephalitis or traumatic brain injury. There are often cases when defects acquired as a result of the disease are minimal and do not interfere with the patient’s full life.
3. Death of the patient caused by progression of the disorder. This outcome is possible in approximately 50 percent of cases. Fluid accumulates in the tissues, which leads to compression of the brain and its deformation, and then to stopping breathing and heartbeat.

The danger of a violation lies in the fact that it is almost impossible to predict exactly what consequences it will lead to in a given case.

Special attention to infants

The brain tissue and nervous system in newborns are in a developing stage, for this reason cerebral edema occurs differently in them than in adults. It develops in a matter of minutes and can be caused by the following factors:

• consequences of birth injuries;
• the presence of intrauterine infections;
• infection either during childbirth or later;
• congenital pathologies of brain development and nervous system.

Suspicion of the development of edema may arise based on the following symptoms:

• the appearance of vomiting;
• inhibited state;
• restless behavior and continuous crying;
• breast refusal;
• convulsions;
• swollen large fontanel even when the child is calm.

With cerebral edema in newborns, symptoms increase quickly, and the child’s condition sharply worsens. In most cases, this condition is fatal within a very short time.

Prevent so you don't die

To prevent swelling of the brain, the following safety measures should be observed:

• give up bad habits: smoking and alcohol abuse;
• avoid head injuries (fasten a seat belt in a car, wear a helmet when riding a bicycle or rollerblading, etc.);
• monitor blood pressure indicators;
• take measures to prevent infectious diseases of the brain;
• normalize weight and eat right;
• promptly treat diseases associated with disorders of the circulatory system.

Following these simple rules will help reduce the risk of a dangerous pathology.

Cerebral edema (CE) is a dangerous complication that progresses due to the development of certain cranial diseases. This abnormal process is characterized by an immense accumulation of intracellular fluid in brain cells. That is, decompensated microcirculatory disorders of the internal structures of the organ occur.

When there are actively developing focal pathological lesions in the brain, which are extremely difficult to treat, the function of self-regulation of vascular tone begins to work incorrectly, which causes rapid dilation of blood vessels. Diffuse swelling of cerebral vessels instantly spreads to healthy areas and initiates an increase in pressure in them.

These pathological modifications end with the fact that the vascular walls lose their usefulness and are unable to retain the watery components of the blood, which, under the influence high pressure leak through them into the brain tissue. The internal structures of the brain are gradually saturated with blood fluid, and each cell of the organ increases several times.

Since the brain space is limited by the intracranial cavity, such deformations cause metabolic dysfunction, as well as complete/fragmentary disruption of the functioning of the brain.

The patient experiences a disorder of consciousness, and overall health deteriorates sharply. If you do not provide the patient with prompt and adequate medical care, the GM will completely cease to function, which in turn can lead to death.

Cerebral edema - classification

Depending on the etiology of the pathological course, there are four main types of cervical edema:

Vasogenic cerebral edema

Usually develops as a result of traumatic brain injuries, encephalitis, with incorrect blood microcirculation, various formations (cancerous/benign) in the structure of the organ, hemorrhagic strokes, etc. It is characterized by high capillary permeability and BBB dysfunction, due to which vascular fluid penetrates beyond the boundaries of the walls and fills the white matter.

Cytotoxic

Formed during head injury, hypoxia and ischemia of the brain. Cytotoxic edema develops rapidly and is localized in the gray matter of the brain. This type is characterized by swelling of neurons, glia and endothelial cells. The activity of the cell membrane is disrupted, sodium in large quantities accumulates in brain cells and, under the influence of osmotic pressure, water penetrates into the internal space of cellular structures.

Interstitial

Occurs with hydrocephalus, otherwise this disease is called “dropsy”. The normal outflow of cerebrospinal fluid in the ventricles is disrupted, and therefore their activity increases and internal pressure increases. Under the influence of the latter, excessive filtration occurs, accumulation of fluid and low molecular weight substances in the brain.

Osmotic

Abnormal changes affect the osmotic vector between the osmolarity of blood plasma and the osmolarity of brain tissue. Osmotic edema of the brain is especially pronounced in patients with acute organ damage and patients with renal failure.

Causes of cerebral edema

The key factors that act as sources of the painful condition include:

1. TBI – mechanical damage bone and tissue structures of the brain lead to the formation of intracranial hematomas, swelling that prevents the release of accumulated fluid outside the brain tissue.
   Ischemic stroke - occurs when cerebral circulation is impaired. Almost no oxygen enters the organ cells, and they gradually begin to die.
2. Hemorrhagic stroke.
3. Infections – mumps, influenza, measles, encephalitis, meningitis, etc.
4. Malignant tumors.
5. Changes in altitude - scientists have found that at an altitude of 1.5 kilometers above sea level, swelling of the brain can develop (this means a rapid increase in altitude without the body getting used to it).
6. Intoxications of an endogenous nature, formed as a result of severe diabetes mellitus, liver dysfunction, acute renal failure.
7. Poisoning with drugs/poisons.
8. Alcoholism.
9. Allergies – Quincke's edema, anaphylactic shock.
10. In infants, the cause of cervical edema can be severe toxicosis in a pregnant woman during gestation, hypoxia, or skull injuries received during childbirth.
11. Brain swelling after stroke

GM swelling after stroke

This is an almost inevitable phenomenon. Most often, pathology occurs in the presence of tumors in the brain. Characterized by the accumulation of fluid in nerve cells. The following signs may indicate the formation of swelling of the brain after a stroke:

• sharp pain in the head;
• causeless vomiting;
• dysfunction of the visual apparatus or partial loss of functions of other senses;
• disorientation in space;
• rapid breathing, palpitations, shortness of breath;
• stupors;
• cramps in the limbs;
• fragmented memory loss;
• dizziness;
• periodic loss of consciousness.

The last symptom is extremely dangerous with swelling of the brain, as it can provoke coma.

Swelling of the GM after surgery

Arises as a consequence postoperative complications. Usually appears within 24 to 72 hours after surgery on the organ. Rapid development, failure of preventive measures after surgery and diagnostic problems can provoke coma.

In order to prevent the formation of edema, the patient must be given corticosteroids and fluid drainage in the first three days.

Alcoholic cerebral edema

Long-term consumption of alcohol-containing drinks over time leads to the destruction of brain cells and the formation of edema. In addition to the symptoms characteristic of the disease, the patient’s physique is noticeably different ( big belly, thin arms/legs), he periodically sees visual hallucinations. There is persistent swelling on the face, skin peel off and have a pronounced bluish tint.

GM swelling due to allergies

Allergic swelling of the brain can be caused by various factors (taking certain medications, eating highly allergenic foods, insect bites, etc.). With this type of pathology, the patient’s condition instantly (within several hours) worsens, and phenomena such as:

1. headache;
2. fear of light and sound;
3. numbness of the occipital region (with this condition it is impossible to press the chin to the chest);
4. vision and speech deteriorate;
5. nausea, in rare cases vomiting is possible;
6. numbness of arms and legs;
7. paralysis.

Symptoms

Symptoms of the pathological process increase gradually as intracranial pressure increases. Common signs of cervical edema in adults include:

• sharp pain in the head that cannot be relieved even with the help of strong antispasmodics;
• constant feeling of nausea;
• vomiting (does not depend on meals and does not bring even short-term relief);
• partial/complete loss of hearing and vision, a feeling of constriction in the eyeballs;
• shortness of breath;
• arrhythmia;
• the patient is poorly oriented in time and space, looks lost, is vaguely aware of real events;
• seizures;
• speech disorder;
• neurology – sleep disturbance, sensitivity, muscle tone, fainting, lack of appetite, tremors, etc.;
• visual hallucinations;
• cerebral palsy, paresis;
• loss of consciousness – as edema progresses, the frequency and duration of attacks increases; in severe cases, a person may fall into a coma.

If a patient exhibits signs of cerebral edema and his condition worsens every day, immediate correction of metabolic disorders is required.

Diagnosis of pathology

An experienced neurologist can detect swelling of the brain at the stage of interviewing the patient or his relatives. To assess the extent of the lesion, the specialist will additionally prescribe an MRI and CT scan of the brain and bone marrow. To establish the actual cause of the formation of a pathological condition, the following is carried out:

1. blood chemistry;
2. lumbar puncture (sampling is carried out extremely rarely, as this may cause
3. additional harm to the patient’s health);
4. other neuroimaging studies at the discretion of the physician.

Treatment

Correct treatment of cerebral edema can be carried out only after identifying the source of the pathology. The main therapy is aimed at eliminating organ dehydration. Certain medical procedures are also performed to relieve the root cause and associated manifestations.

If conservative treatment methods do not produce positive results, then doctors decide on the advisability of surgical intervention (removal of the source of swelling) and trephination of the organ.

Mountain cerebral edema, or resulting from a mild head injury, often goes away on its own, but the patient should always be under 24-hour medical supervision. In such cases, it is necessary to ensure correct blood circulation in the organ to sufficiently saturate the cells with oxygen.

Emergency care for cerebral edema

If any manifestations of cerebral edema appear, you must immediately call ambulance. Before the doctor arrives you should:

1. place the patient on his back on a flat surface;
2. give him sedatives to drink, as well as medicine to lower blood pressure;
3. cover your head in a circle with ice packs or other items from the refrigerator;
4. open all the windows in the room.

Ambulance personnel must mandatory carry out urgent hospitalization in a neurological hospital, where the patient will immediately be given intravenous glucose, piracetam solution, Lasix and glucocorticoids. In addition, he will be wearing an oxygen mask to prevent oxygen starvation of the brain. Subsequently, the patient is sent to the intensive care unit or toxicology department according to indications.

Drug therapy

To effectively treat swelling of the brain, complex drug treatment is carried out:

1. Dehydration therapy. Aimed at removing excess fluid from brain tissue.
2. Infusions using loop and osmotic diuretics, hyperosmolar solutions and other drugs that have a stable diuretic effect are indicated as therapeutic procedures.
3. Oxygenation and improvement of metabolism of brain structures
4. Using these methods, it is possible to achieve restoration of metabolic processes in organ tissues, cell regeneration, stabilization of membrane structures and strengthening of the vascular wall.
5. The patient is given invasions of drugs such as Actovegin, Ceraxon, Cortexini hormones of the glucocorticoid group.
6. Elimination of the cause and relief of accompanying symptoms

Since swelling of the brain always occurs with pronounced manifestations, doctors simultaneously eliminate the existing symptoms along with the main treatment. To solve this problem, antibacterial therapy is often used, and medications are prescribed to detoxify the body.

Surgical removal of lesions is possible only after stabilization and improvement of the patient’s general condition.

Consequences

Even after complete cure of swelling of the brain and removal of the affected areas of the organ, patients rarely manage to return to normal life. There is a great danger of complications and the formation of undesirable consequences in the form of:

• systematic headaches;
• sleep disorders;
• speech, visual and mental abnormalities;
• facial asymmetry;
• strabismus;
• epileptic seizures;
• motor dysfunction.

Prognosis for recovery and survival

Toxic and “mountainous” edema of the brain are the least dangerous for humans, and usually respond well to treatment, provided that the patient was taken to the department on time.

For swelling of another origin, the success of therapy depends on the degree of neglect of the pathology. In the early stages of the disease - painful condition reversible. As the pathological process progresses, the chances of a full recovery rapidly decrease, and even with the effectiveness of treatment procedures, it will not be possible to restore proper functioning of the brain.

Formed comatose states often cause the death of the patient. It is almost impossible to bring a patient out of a coma with significant organ damage.

In any case, if it was possible to achieve regression of symptoms and elimination of swelling, then patients may subsequently experience residual effects after suffering swelling of the brain. These include:

• frequent headaches;
• depression;
• sleep pattern disorder;
• forgetfulness;
• inattention;
• increased intracranial pressure, etc.

In difficult situations there are mental disorders, motor and cognitive dysfunctions that threaten a person with disability.

Cerebral edema (CE) is a pathological condition that is formed as a result of exposure to various factors damaging brain structures: traumatic injury, compression by a tumor, penetration of an infectious agent. Adverse influence quickly leads to excessive fluid accumulation, increased intracranial pressure, which leads to the development of severe complications, which, in the absence of emergency therapeutic measures, can result in the most tragic consequences for the patient and his relatives.

Causes of GM swelling

Normally, intracranial pressure (ICP) in adults is between 3 and 15 mm. rt. Art. In certain situations, pressure inside cranium begins to rise and create conditions unsuitable for the normal functioning of the central nervous system (CNS). A short-term increase in ICP, which is possible with coughing, sneezing, heavy lifting, or increased intra-abdominal pressure, as a rule, does not have time to have a detrimental effect on the brain in such a short period of time, and therefore cannot cause cerebral edema.

It’s another matter if damaging factors leave their influence on brain structures for a long time and then they become the causes of a persistent increase in intracranial pressure and the formation of such a pathology as cerebral edema. Thus, The causes of swelling and compression of the brain can be:

• Penetration of neurotropic poisons, viral and bacterial infections into the GM substance, which happens in the case of poisoning or various kinds of infectious and inflammatory diseases (meningitis, brain abscesses), which can become a complication of influenza and purulent processes localized in organs located in close proximity to the brain (angina, otitis media, sinusitis);
• Damage to brain matter and other structures as a result mechanical impact( – TBI, especially with a fracture of the bones of the vault or base of the skull, and );
• In newborn children - birth injuries, as well as pathology of intrauterine development, the cause of which was illness suffered by the mother during pregnancy;
• , primary or metastases from other organs, compressing nervous tissue, preventing the normal flow of blood and cerebrospinal fluid, and thereby promoting the accumulation of fluid in the brain tissue and increasing ICP;
• Operations performed on brain tissue;
• (stroke) of ischemic (cerebral infarction) and hemorrhagic (hemorrhage) type;
• Anaphylactic (allergic) reactions;
• Climbing to high altitudes (above one and a half km) - mountain edema in persons involved in mountaineering;
• Liver and kidney failure (in the stage of decompensation);
• Withdrawal syndrome in alcoholism (alcohol poisoning).

Any of the listed conditions can cause cerebral edema, the formation mechanism of which in all cases is, in principle, the same, the only difference being that the edema affects only a separate area or spreads to the entire substance of the brain.

A severe scenario for the development of acute brain injury with transformation into brain swelling threatens the death of the patient and looks like this: every cell of the nervous tissue is filled with fluid and stretches to unprecedented sizes, the entire brain increases in volume. Ultimately, the brain, limited by the cranium, begins to not fit in the space intended for it (brain swelling) - it puts pressure on the bones of the skull, causing it to compress itself, since the hard cranium does not have the ability to stretch parallel to the increase in brain tissue, which is why the latter is subjected to injury (compression of the brain). In this case, intracranial pressure naturally increases, blood flow is disrupted, and metabolic processes are inhibited. Cerebral edema develops rapidly and without the urgent intervention of medications, and sometimes surgery, it can return to normal only in some (not severe) cases, for example, when climbing to a height.

Types of cerebral edema arising from the causes

increase in intracranial pressure due to hematoma

Depending on the reasons for the accumulation of fluid in the brain tissue, one or another type of edema is formed.

The most common form of brain swelling is vasogenic. It comes from a disorder of the functionality of the blood-brain barrier. This type formed by increasing size white matter– with TBI, such swelling is already able to manifest itself before the end of the first day. Favorite places for fluid accumulation are nervous tissues surrounding tumors, areas of operations and inflammatory processes, areas of ischemia, and areas of injury. Such swelling can quickly turn into compression of the brain.

Reason for formation cytotoxic edema is most often caused by pathological conditions such as hypoxia (carbon monoxide poisoning, for example), ischemia (cerebral infarction), which occurs due to blockage cerebral vessel, intoxication, which develops as a result of substances (hemolytic poisons) entering the body that destroy red blood cells (erythrocytes), as well as other chemical compounds. In this case, cerebral edema occurs mainly due to the gray matter of the brain.

Osmotic a variant of cerebral edema results from increased osmolarity of the nervous tissue, which can be caused by the following circumstances:

Interstitial type of edema - its cause is the penetration of fluid through the walls of the ventricles (lateral) into the surrounding tissues.

In addition, depending on the extent of the spread of edema, this pathology is divided into local and generalized. Local OMS is limited to the accumulation of fluid in a small area of ​​the medulla, and therefore does not pose such a danger to the health of the central nervous system as generalized swelling of the brain when both hemispheres are involved in the process.

Video: lecture on variants of cerebral edema

How can fluid accumulation in brain tissue manifest itself?

Probably the most typical, although far from specific sign, characterizing the degree of fluid accumulation in the brain matter, is the strongest headache, which is often not relieved by almost any analgesics (and if they are removed, then only by a short time). Such a symptom should especially seem suspicious if there has been a recent traumatic brain injury and the headache is accompanied by nausea and vomiting (also typical signs of TBI).

Thus, the symptoms of AGM are easy to recognize, especially if there were prerequisites for this (see above):

• Intense headache, dizziness, nausea, vomiting;
• Absent-mindedness, impaired attention, inability to concentrate, forgetfulness, decreased communicative (individual) abilities to perceive information;
• Sleep disturbance (insomnia or drowsiness);
• Fatigue, decreased physical activity, constant desire to lie down and abstract from the world around you;
• Depression, state of depression (“the world is not nice”);
• Visual impairment (squint, floaters) eyeballs), disorder of orientation in space and time;
• Uncertainty in movements, changes in gait;
• Difficulty speaking and communicating;
• Paralysis and paresis of the limbs;
• The appearance of meningeal signs;
• Reduced blood pressure;
• Heart rhythm disturbances;
• Convulsions are possible;
• In especially severe cases - clouding of consciousness, respiratory and cardiac dysfunction, coma.

If the brain is swollen and there is no proper treatment, the patient can expect the most dire consequences.– the patient may fall into a stupor, and then into a coma, where there is a very high probability of respiratory arrest and, consequently, the death of a person as a result of this.

It should be noted that in each period of progression of increased intracranial pressure (development), a certain protective mechanism is activated. The capabilities of the complex of compensatory mechanisms are determined by the ability to adapt under conditions of fluid accumulation in the craniospinal system and an increase in brain volume.

Diagnosis and determination of the causes of edema and swelling of the brain, as well as the degree of danger for the patient, is carried out using a neurological examination, biochemical tests blood and instrumental methods (basically, all hopes for magnetic resonance or computed tomography and laboratory).

How to recover?

Cerebral edema, which has formed in a climber due to the desire to gain height faster, or the accumulation of fluid on separate area GM (local edema) arising for another reason, may not require hospital treatment and will go away in 2-3 days. True, a person will be prevented from being particularly active by the symptoms of AMS, which will still be present (headache, dizziness, nausea). In such a situation, you will have to lie down for several days and take pills (analgesics, antiemetics). But in severe cases, treatment may not even be limited to conservative methods - sometimes surgical intervention is required.

For the treatment of cerebral edema from conservative methods use:

1. Osmotic diuretics (mannitol) and loop diuretics (Lasix, furosemide);
2. Hormone therapy, where corticosteroids (for example, dexamethasone) prevent the expansion of the area of ​​edema. Meanwhile, it should be borne in mind that hormones are effective only in the case of local damage, but do not help with the generalized form;
3. Anticonvulsants (barbiturates);
4. Medicines that suppress agitation, have muscle relaxant, sedative and other effects (diazepam, relanium);
5. Vascular agents that improve blood supply and nutrition to the brain (trental, chimes);
6. Proteolytic enzyme inhibitors that reduce permeability vascular walls(contrical, aminocaproic acid);
7. Medicines that normalize metabolic processes in the brain (nootropics - piracetam, nootropil, cerebrolysin);
8. Oxygen therapy (oxygen treatment).

If conservative therapy is insufficiently effective, the patient, depending on the form of edema, is given surgical intervention:

• Ventriculostomy, which is a minor operation that involves draining cerebrospinal fluid from the ventricles of the brain using a hollow needle and catheter;
• Cranial trephination, which is performed for tumors and hematomas (eliminates the cause of OGM).

It is clear that to carry out similar treatment, where surgery is not excluded, the patient is required to undergo mandatory hospitalization. In severe cases, the patient should generally be treated in an intensive care unit, since it may be necessary to maintain basic body functions with the help of special equipment, for example, if a person cannot breathe on his own, he will be connected to a ventilator.

What could be the consequences?

At the beginning of the development of the pathological process, it is premature to talk about the prognosis - it depends on the cause of the formation of edema, its type, localization, rate of progression, general condition of the patient, the effectiveness of therapeutic (or surgical) measures, and, possibly, on other circumstances that are immediately difficult notice. Meanwhile, the development of OGM can go in different directions, and the prognosis, and then the consequences, will depend on this.

Without consequences

With relatively minor swelling or local damage to the brain and effective therapy the pathological process may not leave any consequences. Young healthy people who are not burdened have this chance chronic pathology, however, by chance or by own initiative those who received a mild TBI, which was complicated by edema, as well as those who took alcoholic drinks in large doses or other neurotropic poisons.

Possible disability group

GM swelling medium degree severity, which developed as a consequence of a head injury or an infectious-inflammatory process (meningitis, encephalitis) and was promptly eliminated using conservative methods or surgery, has a quite favorable prognosis; after treatment, neurological symptoms are often absent, but sometimes it is the basis for receiving a disability group . The most common consequences of such OGM can be considered recurrent headaches, fatigue, depressive states, and convulsions.

When the prognosis is extremely serious

The most dire consequences expect the patient with swelling of the brain and its compression. The prognosis here is serious. Displacement of brain structures (dislocation) often leads to cessation of respiratory and cardiac activity, that is, to the death of the patient.

OGM in newborns

In most cases, such pathology in newborns is registered as a consequence of birth trauma. The accumulation of fluid and an increase in brain volume leads to an increase in intracranial pressure, and, therefore, cerebral edema. The outcome of the disease and its prognosis depend not only on the size of the lesion and the severity of the condition, but also on the efficiency of doctors in providing medical care, which must be urgent and effective. More detailed description The reader can find birth injuries and their consequences in. However, here I would like to dwell a little on other factors that form such a pathology as OGM:

1. Tumor processes;
2. (oxygen starvation);
3. Diseases of the brain and its membranes of an infectious-inflammatory nature (meningitis, encephalitis, abscess);
4. Intrauterine infections (toxoplasmosis, cytomegalovirus, etc.);
5. Late gestosis during pregnancy;
6. Hemorrhages and hematomas.

Cerebral edema in newborns is divided into:

• Regional (local), which affects only a certain area of ​​the GM;
• Widespread (generalized) OGM, developing as a result of drowning, asphyxia, intoxication and affecting the entire brain.

Symptoms of increased ICP in children in the first month of life are determined by complications such as infringement of the medulla oblongata, which is responsible for thermoregulation, respiratory function and cardiac activity. Of course, these systems will experience suffering first, which will be manifested by such signs of trouble as increased body temperature, almost continuous screaming, anxiety, constant regurgitation, bulging fontanelle, and convulsions. What's the worst thing - this pathology during this period, due to respiratory arrest, can easily lead to the sudden death of the baby.

The consequences of intracranial hypertension may become apparent as the child grows and develops:

1. Frequent syncope (fainting) conditions;
2. Convulsive syndrome, epilepsy;
3. Increased excitability of the nervous system;
4. Stunting and mental development(impaired memory and attention, mental retardation);
5. Cerebral palsy (cerebral palsy);
6. Consequences of leukomalacia detected in newborns (brain damage caused by ischemia and hypoxia), if it was accompanied by cerebral edema.

Cerebral edema in newborns is treated with diuretics, which help remove unnecessary fluid, corticosteroids, which inhibit the further development of edema, anticonvulsants, vascular agents and angioprotectors, which improve cerebral circulation and strengthen vascular walls.

Finally, I would like to remind the reader once again that the approach to the treatment of any pathology in newborns, adolescents and adults, as a rule, varies significantly, so it is better to entrust this matter to a competent specialist. If in adults a small (local) cerebral edema can sometimes go away on its own, then in newborns you should not hope for this chance; in children in the first days of life, due to the imperfection of the craniospinal system, cerebral edema has a lightning-fast course and at any moment can cause very sad outcome. In young children, this is always a condition that requires urgent, highly qualified care. And the sooner she arrives, the more favorable the prognosis, the greater the hope for a complete recovery.

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Currently answering questions: A. Olesya Valerievna, candidate of medical sciences, teacher at a medical university

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Brain edema (CBE, cerebral edema) is a pathological condition associated with excessive accumulation of fluid in the brain tissue. Clinically, it manifests itself as a syndrome of increased intracranial pressure. With OGM in practical activities Doctors of different specializations face:

• neurosurgeons;
• neurologists;
• neonatologists;
• traumatologists;
• toxicologists;
• oncologists.

Cerebral edema - what is it?

Cerebral edema is not an independent disease, but clinical syndrome, always developing secondary to any damage to brain tissue.

The main triggering factor in the pathogenesis of the development of AMS is microcirculation disorders. Initially, they are localized in the area of ​​cerebral tissue damage and cause the development of perifocal (limited) edema. In case of severe brain damage and untimely initiation of treatment, microcirculatory disorders become total. This is accompanied by an increase in hydrostatic intravascular pressure and dilation of the blood vessels of the brain, which, in turn, causes blood plasma to leak into the brain tissue. As a result, the development of generalized OGM occurs.

Swelling of cerebral tissues causes an increase in their volume, and since they are located in a confined space of the cranium, it also increases intracranial pressure. Blood vessels are compressed by cerebral tissue, which further enhances microcirculatory disorders and causes oxygen starvation of nerve cells and their mass death.

Causes of cerebral edema

The most common causes of OGM are:

• severe traumatic brain injury (basal skull fracture, brain contusion, subdural or intracerebral hematoma;
• ischemic or hemorrhagic stroke;
• hemorrhage into the ventricles or subarachnoid space;
• brain tumors (primary and metastatic);
• some infectious and inflammatory diseases (meningitis, encephalitis);
• subdural empyema.

Much less frequently, the occurrence of OGM is caused by:

• severe systemic allergic reactions (anaphylactic shock, angioedema);
• anasarca caused by renal or heart failure;
• acute infectious diseases (mumps, measles, influenza, scarlet fever, toxoplasmosis);
• endogenous intoxications (liver or kidney failure, severe course diabetes);
• acute poisoning with medications or poisons.

In older people who abuse alcohol, there is an increase in the permeability of the vascular walls, which can lead to the development of cerebral edema.

The causes of OGM in newborns are the following factors:

• severe gestosis;
• umbilical cord entanglement;
• intracranial birth injury;
• protracted labor.

In rare cases, OGM is observed in absolutely healthy people. For example, if a person climbs high into the mountains without the necessary stops to acclimatize the body, he may develop cerebral edema, which doctors call mountain edema.

Classification

Depending on the causes and pathological mechanism of development, several types of OGM are distinguished:

	Cause and mechanism of development
Vasogenic	Most common. It occurs as a result of damage to the blood-brain barrier and the release of plasma into the extracellular space of the white matter. Develops around areas of inflammation, tumors, abscesses, trauma, ischemia
Cytotoxic	The main causes are intoxication and ischemia, which cause intracellular hydration. Usually localized in gray matter and distributed diffusely
Osmotic	The cause of its occurrence is a decrease in blood osmolarity due to inadequate hemodialysis, metabolic disorders, drowning, polydipsia, hypervolemia
Interstitial	Occurs in patients with hydrocephalus as a result of leakage of cerebrospinal fluid into the nerve tissue around the ventricles

Symptoms of cerebral edema

The main symptom of AMS is impaired consciousness varying degrees severity ranging from mild stupor to deep coma.

As the swelling increases, the depth of the disturbance of consciousness also increases. At the very beginning of the development of pathology, seizures are possible. Subsequently, muscle atony develops.

During the examination, the patient is diagnosed with meningeal symptoms.

While consciousness is preserved, the patient complains of a severe headache, accompanied by painful nausea and repeated vomiting, which does not bring relief.

Other symptoms of AMS in adults and children are:

• hallucinations;
• dysarthria;
• incoordination of movements;
• visual disturbances;
• motor restlessness.

With excessive OGM and wedging of the brain stem into the foramen magnum, the patient experiences:

• unstable pulse;
• severe arterial hypotension;
• hyperthermia (increase in body temperature to 40 ° C and above);
• paradoxical breathing (alternating shallow and deep breaths, with different time intervals between them).

Diagnostics

It is possible to assume that a patient has AMS based on the following signs:

• increasing depression of consciousness;
• progressive deterioration of general condition;
• presence of meningeal symptoms.

To confirm the diagnosis, computed tomography or magnetic resonance imaging of the brain is indicated.

Diagnostic lumbar puncture is performed in exceptional cases and with great caution, as it can provoke dislocation of brain structures and compression of the trunk.

To identify the possible cause of OGM, the following is carried out:

• assessment of neurological status;
• analysis of CT and MRI data;
• clinical and biochemical blood tests;
• collection of anamnestic data (if possible).

OHM is a life-threatening condition. Therefore, primary diagnosis should be carried out as quickly as possible and begin from the first minutes of the patient’s admission to the hospital.

In severe cases diagnostic measures carried out simultaneously with the provision of first aid.

Treatment of cerebral edema

The founder of the Soviet school of neurosurgery N. N. Burdenko wrote: “He who masters the art of treating and preventing cerebral edema holds the key to the life and death of the patient.”

Patients with AGM are subject to emergency hospitalization in the intensive care unit. Treatment includes the following areas:

1. Maintaining optimal blood pressure levels. It is desirable that the systolic pressure is not lower than 160 mmHg. Art.
2. Timely tracheal intubation and transfer of the patient to artificial respiration. The indication for intubation is an increase in the intensity of respiratory failure. Mechanical ventilation is performed in hyperventilation mode, which increases the partial pressure of oxygen in the blood. Hyperoxygenation contributes to the narrowing of cerebral vessels and a decrease in their permeability.
3. Facilitation of venous outflow. The patient is placed on a bed with the head end elevated and maximally extended cervical region spine. Improving venous outflow contributes to a gradual decrease in intracranial pressure.
4. Dehydration therapy. Aimed at removing excess fluid from cerebral tissues. It is carried out by intravenous administration of osmotic diuretics, colloid solutions, loop diuretics. If necessary to potentiate the diuretic effect of diuretics and supply neurons nutrients the doctor may prescribe intravenous administration of a hypertonic glucose solution, 25% magnesium sulfate solution.
5. Glucocorticoid hormones. Effective in cases of perifocal cerebral edema caused by the development of a tumor process. Ineffective in cases of acute brain injury associated with traumatic brain injury.
6. Infusion therapy. Aimed at detoxification, elimination of disturbances in water-electrolyte and colloid-osmotic balance.
7. Antihistamines. They reduce the permeability of vascular walls, prevent the occurrence of allergic reactions, and are also used to relieve them.
8. Drugs that improve cerebral blood circulation. They improve blood flow in the microvasculature, thereby eliminating ischemia and hypoxia of nervous tissue.
9. Metabolic regulating agents and nootropics. Improve metabolic processes in damaged neurons.
10. Symptomatic therapy. Includes the prescription of antiemetics, anticonvulsants, and painkillers.

If AGM is caused by an infectious-inflammatory process, in complex therapy include antiviral or antibacterial drugs. Surgical treatment is carried out to remove tumors, intracranial hematomas, and areas of brain crushing. For hydrocephalus, shunt surgery is performed. Surgery is usually performed after the patient's condition has stabilized.

Complications

With a significant increase in intracranial pressure, dislocation (displacement) of brain structures and infringement of its trunk in the foramen magnum can be observed. This leads to severe damage to the respiratory, vasomotor and thermoregulatory centers, which can cause death against the background of increasing acute cardiac and respiratory failure and hyperthermia.

Consequences and prognosis

IN initial stage development of OHM is a reversible condition, but as the pathological process progresses, the death of neurons and destruction of myelin fibers occurs, which leads to irreversible damage to brain structures.

With early initiation of treatment for acute toxicity in young people and initially healthy patients complete restoration of brain function can be expected. In all other cases, residual effects of varying severity will be noted:

• persistent headaches;
• absent-mindedness;
• forgetfulness;
• depression;
• sleep disorders;
• increased intracranial pressure;
• disorders of motor and cognitive functions;
• mental disorders.

Prevention

Measures primary prevention cerebral edema are aimed at preventing the causes underlying its development. These may include:

• prevention of industrial, road transport and domestic injuries;
• timely detection and active treatment arterial hypertension and atherosclerosis, which are the main causes of stroke;
• timely treatment of infectious and inflammatory diseases (encephalitis, meningitis).

If a patient has a pathology against which the development of cerebral edema is possible, then he must undergo preventive treatment aimed at preventing swelling of the brain substance. This may include:

• maintaining normal plasma oncotic pressure (intravenous administration hypertonic solutions, albumin, fresh frozen plasma);
• prescription of diuretics for high intracranial pressure;
• artificial hypothermia - allows you to reduce the energy needs of brain cells and thereby prevent their mass death;
• the use of drugs that improve the tone of cerebral vessels and metabolic processes in brain tissue.

Video

We offer you to watch a video on the topic of the article.

This complication, depending on its severity, can go almost unnoticed, for example, with a mild concussion. But most often the consequences of cerebral edema are severe complications:

changes in mental and mental activity;

motor dysfunction;

coordination functions, which leads to disability of the patient;

Quite often, cerebral edema causes death.

What is cerebral edema?

The essence of the definition of this condition is the nonspecific response of the entire organism to the influence of severe damaging factors. The latter may be the reason:

changes in plasma protein (oncotic) and electrolyte (osmotic) pressure;

violations of the acid-base state (pH) of the blood;

disruption of energy, protein and water-electrolyte metabolism and accumulation in nerve fibers lactic acid;

oxygen starvation of brain tissue, especially if it is combined with excessive accumulation of carbon dioxide in the blood;

disturbance of blood microcirculation in brain tissue.

All these reasons provoke the development of swelling and edema of the brain. Edema provokes a violation of the permeability of the capillary walls and the release of the liquid part of the blood into the surrounding tissues. When swelling occurs due to the difference in oncotic pressure, water molecules begin to flow directly into the nerve cells through the membrane. Here they interact with intracellular proteins, as a result, the cells increase in volume.

However, most authors of scientific studies consider swelling as one of the stages of edema, which leads to an increase in the volume of the brain. This situation provokes its displacement around its axis in a confined space, which is limited by the bones of the skull.

The spread of cerebral edema causes compression of the medulla oblongata and other underlying structures in the foramen magnum. This zone contains vital regulatory centers that control thermoregulation, cardiovascular activity, and respiration.

Signs of cerebral edema are manifested by impaired functioning of brain centers and nerve cells even before the onset of complete damage to the structures of the latter, which is determined only with the help of modern diagnostic methods.

Types and causes of cerebral edema

There are 2 types of cerebral edema:

regional or local edema - limited to a certain area that surrounds the pathological formation in the brain tissue; cyst, hematoma, tumor, abscess;

widespread or generalized – covers the entire brain. Develops due to the loss of a large volume of protein in the urine during poisoning and various diseases, intoxication, drowning, suffocation, traumatic brain injury, with hypertensive encephalopathy, which occurs against the background of severe forms of increased blood pressure and other disorders.

In many cases, excluding asphyxia and traumatic brain injury, identifying cerebral edema is a difficult task against the background of clinical manifestations of other pathological conditions and diseases. The onset of the development of edema can be suspected when, against the background of a lack of progress or a decrease in the symptoms of the underlying disease, neurological symptoms begin to increase and progress.

The main reasons for the development of cerebral edema:

traumatic brain injury, laryngeal stenosis if the child has acute respiratory infection, asphyxia with vomit after an alcoholic coma, brain contusion;

subarachnoid hemorrhage, which occurs due to a stroke in the presence of high blood pressure;

brain tumors;

subdural hematoma, which forms under the dura mater as a result of exposure to mechanical factors without compromising the integrity of the bones of the skull;

cerebral edema in newborns due to birth trauma to the child’s brain, severe gestosis in the mother, prolonged labor, umbilical cord entanglement;

poisoning with medications, gases, chemical poisons;

heavy allergic reactions, anaphylactic shock;

severe diabetes mellitus, especially if it occurs with episodes of hypoglycemic state, hepatorenal or liver failure chronic or acute form;

diseases that are accompanied convulsive syndrome– epilepsy, heat stroke, hyperthermia in children with infectious diseases;

gestosis in the second half of pregnancy - eclampsia, preeclampsia, severe nephropathy;

acute infectious diseases - encephalitis, meningitis, influenza, including severe childhood infections - chicken pox, scarlet fever, measles, mumps.

In addition, cerebral edema is almost always observed after cranial surgery. In some cases - after operations that are performed under epidural or spinal anesthesia or are accompanied by significant blood loss due to a prolonged and pronounced decrease in blood pressure, with intravenous administration excessive amounts of hypotonic or saline solutions during surgery, as a result of difficulties in tracheal intubation to provide artificial ventilation or inadequate anesthesia and ventilation.

Symptoms of cerebral edema

Depending on the duration of the disease, localization of the lesion, rate of increase and extent of the process clinical manifestations cerebral edema may vary. Limited (local) edema is manifested by general cerebral symptoms, much less often these are signs that are characteristic of a specific part of the brain. With the increase or presence of initially generalized edema, but slowly increasing, there is a gradual increase in the number of symptoms, which mean damage to several parts of the brain at once. All symptoms can be divided into groups.

Signs of increased intracranial pressure:

lethargy and drowsiness;

gradual increase in depression of consciousness with the appearance of nausea and vomiting;

dangerous convulsions - clonic (short-term, sweeping contractions of the muscles of the face and limbs), tonic (prolonged muscle contractions, as a result of which certain parts of the body acquire an unusual position for themselves), clonic-tonic, provoking an increase in cerebral edema;

a rapid increase in intracranial pressure provokes the development of bursting headaches, disturbance of eyeball movement, and repeated vomiting;

cerebral edema in infants (children under 1 year of age) provokes an increase in head circumference; after the fontanelles close, their opening develops due to displacement of the bones.

The appearance of scattered (diffuse) neurological symptoms

The phenomenon is reflected by the increase in the pathological process, which carries the risk of developing coma in the presence of cerebral edema. This is provoked by the involvement of the cerebral cortex in the initial process, after which subcortical structures are also involved. In addition to impaired consciousness and the patient’s transition into a coma, the following develop:

pathological grasping and defensive reflexes;

psychomotor agitation in the intervals between attacks of convulsions, the latter are of the epileptic type and occur with a predominance of muscle hypertonicity;

widespread (generalized) repeated seizures.

Group of the most dangerous symptoms

They are associated with the continued increase in cerebral edema and dislocation of its structures, followed by herniation or pinching in the area of ​​the foramen magnum. Signs include:

Coma (various degrees).

Hyperthermia (above 40 degrees), it cannot be controlled with antipyretics and vasodilators. In some cases, a slight decrease in temperature can be achieved only when areas are exposed to cold large vessels or carrying out general hypotremia.

There are different pupil sizes and lack of reaction to light, floating eyeballs, strabismus, unilateral convulsive contraction of the extensor muscles and unilateral paresis, absence of tendon and pain reflexes, heart rhythm disturbances, and a tendency to reduce the number of heart beats.

If the patient is not subjected to artificial ventilation, the depth of breathing and frequency first increase, then the breathing rhythm is disrupted, and as a result, respiratory and cardiac activity stops.

Diagnostics

IN outpatient setting It is quite difficult to diagnose cerebral edema, since the phenomenon does not have any specific neurological symptoms. In the early stages, the complication may be asymptomatic or minimally symptomatic. The diagnosis is made based on the symptoms of the underlying disease or injury that caused the swelling; an examination of the fundus is also informative.

If cerebral edema is suspected, the patient should be kept in the neurosurgery or intensive care unit. In a hospital setting, a decision is made regarding the need to perform a lumbar puncture and angiography. In the diagnostic process, CT and MRI are also informative, which help diagnose edema and determine the degree of its prevalence and severity.

Consequences of cerebral edema in children and adults

The earlier this pathological condition is diagnosed and intensive medical care is provided, the higher the chances of a full recovery. In the intensive care unit, restoration of blood supply to the brain, dehydration therapy, and restoration of liquor dynamics are carried out; the prognosis depends on the severity of the pathology.

In the presence of small perifocal edema, complete recovery is possible, whereas with the development of cystic-atrophic processes in the brain tissue, only partial restoration of functionality can be achieved. When treating only the underlying pathology, which is accompanied by cerebral edema, recovery is not always possible, and a high risk of death remains.

The success of therapy and the consequences for the patient depend on the severity of the pathology that provoked the development of such serious condition and the degree of edema itself, which in some cases ends in complete recovery. In severe cases, the following are observed:

When the edema is localized in the medulla oblongata, the location of the main life support centers, the consequences of cerebral edema can be impaired blood supply, epilepsy, convulsions, and breathing problems.

Even after appropriate treatment, the patient may experience increased intracranial pressure, which greatly worsens the patient’s quality of life, as it is accompanied by headache, drowsiness, lethargy, decreased social communication skills, loss of patient orientation in time, and disturbance of consciousness.

Infringement of the brain stem is especially dangerous; its displacement is also dangerous, which threatens the development of paralysis and respiratory arrest.

After therapy and rehabilitation, many patients have residual adhesions between the meninges, in the cerebrospinal fluid spaces or in the ventricles of the brain. This also provokes the development of headaches, depression, and disorders of neuropsychic activity.

With prolonged cerebral edema without appropriate therapy, brain function disorders may subsequently occur, which are manifested by a decrease in a person’s mental abilities.

Children may also experience complete recovery or:

mental retardation and neuropsychic instability;

impaired motor coordination and speech;

dysfunction internal organs and epilepsy;

development of hydrocephalus and cerebral palsy.

Cerebral edema is a serious, in most cases extremely severe, pathology that requires immediate diagnosis, adequate treatment and observation in adults by a psychoneurologist and neurologist, and in children by a neurologist and pediatrician. The duration of observation and therapy after suffering from cerebral edema depends on the severity of residual pathology.

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Brain swelling

Cerebral edema is the accumulation of fluid in the cells and intercellular space of the brain, which causes an increase in its volume and intracranial hypertension. This is a secondary pathology, which is characterized by rapid development. Without timely medical intervention, the consequence of cerebral edema can be fatal.

Causes of cerebral edema

Brain swelling occurs as a response of the body to injuries, infections or diseases associated with impaired brain function.

In case of traumatic brain injury, mechanical damage can be complicated by the entry of fragments of cranial bone into the brain tissue. As a result, the normal outflow of fluid is disrupted. This is possible after a fall from a height, a blow to the head or an accident. Newborns are likely to experience birth injuries.

The following infectious and inflammatory diseases can cause cerebral edema:

• Meningitis - inflammation meninges because of viral infection or uncontrolled use of medications;
• Encephalitis is a viral inflammation that most often occurs after the bite of various insects;
• Subdural empyema is a purulent complication of infections;
• Toxoplasmosis is an infection caused by Toxoplasma, which is transmitted from domestic animals.

Ischemic stroke is the direct cause of cerebral edema - blood circulation is impaired as a result of blockage of a vessel by a thrombus. Cells experience oxygen starvation and gradually die, which provokes the accumulation of fluid.

In the presence of a tumor, cerebral edema is a common occurrence, since tumor cells grow rapidly and put pressure on healthy ones.

In some cases, the development of this pathology may be associated with professional activity or sports. For example, climbers often have so-called mountain cerebral edema associated with sudden changes in altitude.

Symptoms of cerebral edema

Symptoms of cerebral edema include:

• Uneven breathing;
• Dizziness;
• Nausea and vomiting;
• Strong headache;
• Partial loss of vision;
• Disorientation in space;
• Speech impairment;
• Memory losses;
• Falling into a stupor;
• Periodic seizures;
• Fainting.

If these signs appear, immediate medical attention is required.

Depending on the severity and location of the underlying disease, the consequences of cerebral edema will be various complications:

• Increased intracranial pressure. Accompanied by inhibition of reactions, drowsiness, disorders of consciousness, loss of social communication skills;
• Impaired breathing and blood supply. Appears when the medulla oblongata is damaged, where all the main life support centers are located;
• Asthenia of the nervous system, epilepsy. It happens after intensive rehabilitation therapy, as adhesions remain in the cerebrospinal fluid spaces, ventricles and membranes;
• Incorrect functioning of the cortex. Caused by prolonged cerebral edema, affects thinking process, leads to the development of decortication;
• Tetraparesis, paralysis. Occurs when the brain stem is herniated and displaced;
• Respiratory arrest, death. Possible in case of vital impairment important functions due to infringement of the brain stem in the foramen of the cerebellar tentorium or with an uneven increase in the volume of the hemispheres.

Treatment of cerebral edema

Treatment of cerebral edema consists of eliminating its cause, reducing intracranial pressure and supplying the brain with the necessary amount of oxygen. Medicines are selected depending on the underlying disease and severity of symptoms. For example, for traumatic brain injuries, oxygen therapy is used, during which oxygen is artificially introduced into the body. If there is excessive accumulation of fluid in the ventricles, it is removed using a special catheter, which helps relieve high pressure.

The most difficult method of treating cerebral edema is surgery, but sometimes this is the only way to save the patient’s life. Surgeries are necessary for tumors, damage to brain tissue by the bones of the skull, as well as for the restoration of damaged blood vessels.

Sometimes brain swelling can disappear on its own, after a minor accident or mild concussion, but for most people, the accumulation of excess fluid in the brain does not go away without a trace. Therefore, a doctor should always determine the degree of danger, and diagnosis is necessary even for minor injuries.

Video from YouTube on the topic of the article:

The information is generalized and is provided for informational purposes. At the first signs of illness, consult a doctor. Self-medication is dangerous to health!

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Brain swelling

Cerebral edema is a reaction of the body's response to excessive stress, injury or infection. The process develops quickly: cells and intercellular space are filled with an excessive amount of fluid, the brain increases in volume, and as a result, intracranial pressure (ICP) increases, cerebral circulation worsens, and cell death begins.

The outcome depends on the speed and quality of qualified medical care, which, ideally, should be immediate and as effective as possible. Failure to comply with this norm increases the risk of mortality of this condition.

Causes

• Traumatic brain injury (TBI) is the result of an accident, fall or blow. Bone fragments often injure the brain and cause swelling;
• Intracranial hemorrhage;
• Infectious diseases such as meningitis, encephalitis, toxoplasmosis, subdural abscess, etc.
• A disease that affects brain function. For example, with an ischemic stroke, brain cells are left without food - oxygen. This leads to the development of edema;
• A sharp change in altitude (from 1.5 km above sea level).

Symptoms and signs of cerebral edema

Symptoms vary, depending on the cause and severity of the condition. General signs the processes are as follows:

Diagnostics

General diagnostic methods:

• Neurological examination;
• MRI and CT scan of the brain (localization and size of edema);
• Blood test (detects possible cause of swelling).

Treatment

It happens that the symptoms of the disease go away on their own after a few days (for example, with a mild form of mountain sickness, a minor concussion). In other cases, immediate assistance from a qualified specialist is required.

First of all, treatment is aimed at restoring full oxygen metabolism in brain cells by combining surgical and medicinal methods. This helps eliminate swelling, and all the better if the therapy was carried out in a timely manner - recovery will take less time, and serious destructive changes can be avoided.

• Oxygen therapy – in other words, the introduction of oxygen into the respiratory tract artificially, using an inhaler or other devices. Blood saturated with oxygen in this way will much better nourish damaged brain cells, which has a beneficial effect on the timing and quality of recovery.
• Intravenous fluids are used to maintain blood pressure and flow within normal limits and to fight possible infection.
• Hypothermia (lowering body temperature) is a good way to correct cerebral edema. However, it is not widely used now.
• The choice of medications directly depends on the symptoms and cause of edema.
• To reduce ICP, ventriculostomy is performed - drainage of excess fluid from the ventricles of the brain through a catheter.
• In severe cases, surgical intervention is performed:
  • Decompensated craniectomy – a fragment of the skull bone is removed to reduce ICP;
  • Eliminate the cause of swelling, for example, restore blood vessel damaged, or the identified tumor is removed.

Consequences

Brain edema is always damage to brain cells and tissues of varying severity, which, as a rule, entails further consequences, in the form of disturbances:

• sleep patterns;
• concentration;
• motor activity;
• communication ability;
• emotional state (depression).

Doctors are obliged to do their best to reduce their negative effect to a minimum. Of course, in addition to the problems listed above, others may develop, it all depends on the location of the department, but these are the most common. Also, don’t forget about headaches.

Cerebral edema in newborns

This disease is not uncommon in children; the reasons can be very diverse:

• Tumor;
• Stroke;
• Meningitis;
• Malignant course of hypertension;
• Encephalitis;
• Hypoxia;
• Occlusive hydrocephalus.

In addition, the following predisposes to the disease:

• Various maternal illnesses;
• Toxicoses suffered during pregnancy, leading to hypoxia of the mother and fetus;
• Traumatization of the baby when passing through the birth canal.

Treatment of cerebral edema in children

Upon admission to the hospital, the victim is provided with assistance to restore vital functions:

• Normalize blood pressure
• Replenish circulating blood volume
• The patient is connected to a ventilator. Moderate hyperventilation mode.

You can find out the symptoms and consequences of a brain contusion at the link provided.

• Muscle relaxants that are not fully effective - you need to notice convulsions, focal symptoms, return of consciousness.
• Osmodiuretics to remove excess fluid. (optional: solution of mannitol 10, 15 or 20%, sorbitol 40% or glycerol, taking into account all contraindications).
• Saluretics (furosemide) are prescribed to prolong the effect of mannitol solution.
• Corticosteroids inhibit the development of edema
• Barbiturates, to reduce the severity of cerebral edema and suppress seizure activity.
• Hypothermia is a protective effect during ischemia, stabilizing enzyme systems and membranes, but it does not improve blood flow, but even reduces it (blood viscosity increases). In addition, the risk of contracting an infection increases.
• Sometimes the drugs Cavinton or Trental are used (normalization of vascular tone); contrical or gordox (proteolytic enzyme inhibitors); as well as dicinone, troxevasin or ascorutin (stabilize cell membranes and angioprotectors).

Consequences

• If edema has led to the death of cells in the cortical structures of the brain, depending on the severity of the damage, a decrease in intellectual abilities is observed - from mild non-critical forms to severe mental defects.
• Not only mental abilities are impaired, but also the extensor positions of the limbs, a “thrown head”, strabismus are possible, pathologies of grasping/sucking reflexes, etc. can also develop.
• If assistance is provided untimely or incorrectly, or perhaps the brain damage was initially too extensive (it is worth noting that newborn children have an especially high risk of TBI - the fontanelles are not yet closed), a fatal outcome cannot be ruled out.

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Comments

A granddaughter was born on January 27 and was discharged as usual after 5 days with cerebral edema. They told me to come back in a month. I think the reason is that my mother had sinusitis before giving birth, they pumped fluid out of her and she exceeded the deadline set by the doctors. I’m very worried about my granddaughter, they are in Krasnoyarsk and I’m in Sakhalin. Maybe I should treat it right away and not wait a month? Thank you.

Development of cerebral edema: what are the symptoms and how is treatment carried out?

Cerebral edema is a severe condition in which damage occurs to all structures of this organ. Brain tissue is saturated with fluid contained in this part of the body, as a result of which the functioning of the entire system and vascular space is disrupted.

Formation mechanism

The symptoms of the pathology are very vivid, and the lack of emergency treatment can lead to the death of the patient. We must not forget that alcohol is considered one of the most common provoking factors leading to this disease. Alcohol negatively affects all parts of the body, and the brain the most strongly. Although, of course, this is far from the only cause of pathology.

The mechanism of development of the disease depends on the cause of cerebral edema. Any disturbance in this area that affects blood flow is a factor predisposing to this disease. It is these effects that change the course of biochemical processes in the organ, which is manifested by swelling.

Under what conditions can edema develop:

1. Improper blood supply to organ tissues.
2. Decreased oncotic pressure of blood plasma due to excessively low protein levels.
3. Lack of oxygen caused by excess carbon monoxide in the blood.
4. Disorder of metabolic processes in the cells of the nervous system, water-electrolyte, protein and others.

There are several types of cerebral edema, which are determined by the total amount of tissue damage in this area. The symptoms and treatment of each form of the disease will also depend on the type of pathology. Types of edema:

1. Regional or local. Such edema differs in localization; they usually form near the pathological focus, without spreading far beyond its boundaries.
2. Diffuse (penetrating). It is usually recorded in people who have suffered accidents, since it is during sudden braking or, conversely, acceleration that one can get injured, causing such damage.
3. Generalized (complete). The causes of this type of cerebral edema can be very diverse: stroke, carbon monoxide poisoning, and much more. Such a disorder is often not tied to a particular hemisphere.

If such a destructive process was large-scale, then the axons of the organ rupture and microhemorrhages form. In the immediate vicinity of the injury site, there is a retention of cerebrospinal fluid ( cerebrospinal fluid) or the appearance of cerebral edema. Such conditions are deadly, their consequences can be irreparable, blood pressure drops quickly, collapse and coma develop, which can be very long.

Causes of pathology

Normal intracranial pressure in each person is 4-15 mmHg. Art. These indicators may change under the influence of certain factors and may be short-term. If people sneeze, cough, or lift heavy objects, these readings increase. This condition is not dangerous, as it does not cause unpleasant symptoms and does not provoke cerebral edema. When the pressure inside the skull rises significantly and is a consequence of pathological processes, the functioning of the central nervous system is disrupted and other complications develop.

What could be the reason:

1. Mechanical impact on the organ: craniocerebral injuries, especially accompanied by fractures of the bones of the base or vault of the skull, the formation of hematomas inside the skull, hemorrhages in this area.
2. Damage to the brain by various poisons, bacteria or viruses. Purulent and others inflammatory processes in this area of ​​the body, they disrupt the functioning of the organ and cause swelling of the brain. Diseases such as meningitis, encephalitis, and abscess are dangerous. Such ailments are sometimes a complication of other diseases in which the pathological process is localized near the brain.
3. Allergic reaction of the body.
4. When engaging in mountaineering, people often develop this condition, since climbing to great heights provokes a similar process.
5. Brain tumors cystic formations, metastasis from other parts of the body during cancer does not allow the cerebrospinal fluid to circulate normally, due to which swelling is formed.
6. Ischemic and hemorrhagic strokes, after which there is a violation of blood circulation in the organ.
7. Kidney or liver failure.
8. Cerebral edema in newborns is usually a consequence of trauma during childbirth or pathological processes during intrauterine development.
9. Diseases of the cardiovascular or respiratory system. With such ailments, it may be difficult for oxygen to reach the individual bodies and body tissues, including the brain. Such disorders are one of the main causes of cerebral edema.
10. With epilepsy, such a disorder can also be observed. Seizures in this disease can cause hypoxia or oxygen starvation, as well as a disorder of metabolic processes in the organ. This situation is very dangerous and often provokes the formation of cerebral edema in adults, elderly people and even children.

Not only intracranial factors can cause the onset of such a pathological process; this condition may indicate serious complications of diseases of other organs (kidneys, liver, heart, etc.).

Alcohol is also a common cause of edema, and people who drink alcohol are at risk. Patients suffering from alcoholism often experience withdrawal symptoms or poisoning, which provokes the accumulation of cerebrospinal fluid.

Many people do not attach much importance to the quality and quantity of alcohol. Alcohol may be produced without passing the necessary tests and contain deadly poisons. When drinking such a drink, the likelihood of death increases many times over. If you exceed the permissible limit, you can also expect the appearance of cerebral edema and other serious consequences. Today, alcohol is more dangerous than ever, but few people think about it.

Symptoms and diagnostic methods

The clinical picture of this condition will not go unnoticed, the symptoms manifest themselves intensely, and the patient’s well-being worsens every hour. A person needs urgent treatment, since without the necessary therapeutic measures, death is possible.

• headache that can become very intense;
• dizziness;
• sleep disorder, increased drowsiness or insomnia;
• impaired concentration; during a conversation, a person cannot adequately perceive the interlocutor;
• memory loss;
• loss of strength, weakness, depression, depression, nausea and vomiting;
• visual impairment, strabismus may develop or the eyeballs may become floating;
• speech changes, the patient finds it difficult to pronounce words correctly and communicate with people;
• changes in gait, movements become slow and uncertain;
• lowering blood pressure;
• heartbeat failure;
• convulsive manifestations;
• paresis of limbs or paralysis;
• impaired consciousness, fainting;
• breathing problems;
• cardiac dysfunction and development of coma (in difficult cases).

Symptoms of cerebral edema as in early stage the formation of the disease, and in a later period, depend on the force of pressure inside the cranium. If swelling of the organ occurs, the situation becomes extremely difficult. Several signs of this condition do not always appear at once; at an early stage of development, only weakness and headache can be observed. However, even with minor manifestations of this disease, you should consult a doctor.

Diagnosing cerebral edema is not difficult. Modern medicine has technology that allows us to identify a disease at any stage of its formation.

In particular, the following examination methods are used:

1. MRI (magnetic resonance imaging).
2. Identification of deviations in the reflex qualities of the human nervous system, the presence of pathological reflexes.
3. CT (computed tomography).
4. Lumbar puncture.
5. Fundus examination.

Cerebral edema in children manifests itself less specifically than in adults, but it can be determined by external signs. Sometimes it is advisable to begin treatment of a patient before receiving the results of the examination if there is a risk of death of the patient.

Features of development and treatment

An important part of therapy is finding and eliminating the cause of the disease. All manipulations by doctors are carried out exclusively in conditions intensive care unit hospitals. In especially severe cases of this disease, doctors resort to surgery.

Possible complications

Cerebral edema has 3 stages, which determine treatment, prognosis and possible development complications:

At the initial stage, cerebral edema is considered reversible and does not cause significant harm to human health. The severe course of the disease is more severe and requires immediate therapeutic measures, since their absence can lead to the terminal stage and death of the patient.

The consequences of cerebral edema can develop even after a course of therapy. It is quite difficult to prevent complications from occurring. When treatment for pathology is started in a timely manner, there is a high probability of a favorable outcome.

• mental and mental disorders;
• impairment of motor activity and coordination;
• visual dysfunction;
• the person becomes uncommunicative and unadapted to independent life;
• long stay in a coma and death.

Symptom in children

Causes similar condition may be different for a child. Much depends on the age of the patient. If we are talking about children 1-6 months old, then most likely the pathology developed as a result of birth trauma or improper intrauterine formation of the fetus. When the disease is detected in an older child, it means that the cause was another illness or injury.

Causes of swelling in children:

• consequences of suffocation or drowning;
• skull injury or concussion;
• laryngeal stenosis resulting from respiratory diseases;
• neoplasms in the brain;
• diseases of infectious nature;
• high body temperature;
• ischemic stroke;
• chronic pathologies: diabetes mellitus, kidney and liver failure, epilepsy;
• formation of a hematoma over the area of ​​the dura mater;
• sudden changes in atmospheric pressure.

Manifestations of the disease in children of different ages are also different. If the child is from 6 months to 2 years old, then the doctor can easily determine the pathology by the presence of a convex fontanel and an increase in head circumference. In older children, during a visual examination, the doctor may not detect any changes.

Therapy methods

It is important to properly provide first aid to the patient, stabilizing the heart function, breathing and pressure inside the skull. Next, a number of medications are prescribed to help relieve swelling.

1. Glucocorticoids (Dexamethasone).
2. Vasoactive agents (Methyldopa, Clonidine).
3. Angioprotectors (Parmidine, Etamzilat).
4. Drugs that stabilize cell membranes (Difenin).
5. Blockers calcium channels(Verapamil).
6. Proteolysis enzyme inhibitors (Pantripin).
7. Medicines that improve rheological properties blood (Reopoliglucin).
8. Diuretics (Furosemide).

Many people do not understand why they developed cerebral edema. Nonpathological causes of fluid accumulation in this organ, such as mountain sickness, usually do not cause significant harm. A person’s condition returns to normal within a few days at home. In case of severe brain disorders, medical intervention cannot be avoided. Alcohol and other poisons can harm people and provoke swelling of brain tissue, but the influence of these factors can only be identified in a hospital setting.

Diseases complicated by this disease require careful diagnosis and therapy. Indeed, even after successful treatment of cerebral edema, there remains a risk of re-accumulation of fluid in this area, so only by eliminating the provoking factor can one hope for a complete recovery.