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Why does my brain feel swollen. Cerebral Edema: Understanding Brain Swelling, Symptoms, and Treatment Options

by alexxlab

What is cerebral edema. How does brain swelling occur. What are the common symptoms of cerebral edema. Which conditions can lead to brain swelling. How is cerebral edema diagnosed and treated. Can brain swelling be prevented.

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What is Cerebral Edema and How Does It Occur?

Cerebral edema, commonly known as brain swelling, is a serious medical condition characterized by an increase in intracranial pressure due to excess fluid accumulation in the brain tissue. This swelling can disrupt the delicate blood-brain barrier and potentially lead to severe complications if left untreated.

The brain, being encased within the rigid structure of the skull, has limited space to expand. When swelling occurs, it can impede the flow of oxygen-rich blood to brain cells, obstruct the drainage of cerebrospinal fluid, and ultimately cause damage or death of brain tissue.

Types of Cerebral Edema

There are four main types of cerebral edema:

  • Cytotoxic edema: Occurs when cells within the brain swell due to metabolic disturbances
  • Vasogenic edema: Results from a breakdown of the blood-brain barrier, allowing fluid to leak into surrounding tissues
  • Interstitial edema: Caused by an accumulation of cerebrospinal fluid within the brain
  • Osmotic edema: Develops due to electrolyte imbalances affecting fluid distribution in the brain

Of these, vasogenic edema is the most common type encountered in clinical practice.

Recognizing the Signs and Symptoms of Brain Swelling

The symptoms of cerebral edema can vary widely depending on factors such as the underlying cause, the patient’s age, brain size, and the specific location of the swelling. It’s important to note that brain swelling itself is often a consequence of another condition rather than the initial presenting symptom.

Common signs and symptoms of cerebral edema include:

  • Persistent headache (the most frequent symptom)
  • Dizziness and vertigo
  • Nausea and vomiting
  • Changes in mood or behavior
  • Cognitive impairment
  • Altered state of consciousness
  • Seizures
  • Loss of coordination
  • Numbness or weakness (generalized or localized)
  • Double vision or other visual disturbances

In infants, a noticeable bulging of the soft spots on the skull (fontanelles) may be observed.

Underlying Causes and Risk Factors for Cerebral Edema

Brain swelling can result from various medical conditions and traumatic events. Understanding these causes is crucial for proper diagnosis and treatment.

Traumatic Brain Injury (TBI)

TBI is a significant cause of cerebral edema. It occurs when an external force damages the brain, leading to bruising, bleeding, or swelling. Common causes of TBI include:

  • Falls
  • Motor vehicle accidents
  • Sports-related injuries
  • Physical assaults
  • Combat-related injuries

The trauma can compromise the blood-brain barrier, resulting in abnormal fluid accumulation and increased intracranial pressure.

Infections Affecting the Brain

Certain infections can lead to inflammation and swelling of brain tissue. Two primary examples are:

  1. Encephalitis: Inflammation of the brain, typically caused by viral infections
  2. Meningitis: Infection of the protective membranes (meninges) surrounding the brain and spinal cord

These infections can be caused by various pathogens, including viruses, bacteria, fungi, and parasites.

Brain Tumors

Abnormal growths within the skull can lead to cerebral edema by:

  • Compressing or displacing healthy brain tissue
  • Obstructing the flow of cerebrospinal fluid
  • Inducing localized inflammation

Stroke

Ischemic strokes, which account for approximately 87% of all strokes, can result in cerebral edema. When blood flow to a region of the brain is blocked, injured brain cells swell, potentially obstructing cerebrospinal fluid drainage and further increasing intracranial pressure.

Diagnosis and Assessment of Cerebral Edema

Accurately diagnosing cerebral edema requires a combination of clinical evaluation and advanced imaging techniques. Healthcare providers typically follow a systematic approach to assess the presence and severity of brain swelling.

Clinical Evaluation

The initial assessment involves a thorough physical examination and neurological assessment. Doctors will look for signs such as:

  • Altered mental status
  • Abnormal pupil reactions
  • Changes in vital signs (blood pressure, heart rate, respiratory rate)
  • Focal neurological deficits

Imaging Studies

Advanced imaging techniques play a crucial role in diagnosing cerebral edema. Common imaging modalities include:

  1. Computed Tomography (CT) scan: Provides detailed cross-sectional images of the brain, helping identify areas of swelling, bleeding, or structural abnormalities
  2. Magnetic Resonance Imaging (MRI): Offers high-resolution images of brain tissue, allowing for more precise evaluation of edema and its underlying causes
  3. Intracranial Pressure Monitoring: In severe cases, a pressure sensor may be surgically implanted to continuously measure intracranial pressure

Treatment Approaches for Cerebral Edema

The management of cerebral edema focuses on reducing intracranial pressure, addressing the underlying cause, and preventing further brain damage. Treatment strategies may vary depending on the severity and etiology of the swelling.

Medical Management

Initial treatment often involves medical interventions to control intracranial pressure:

  • Osmotic diuretics (e.g., mannitol): Help draw excess fluid out of the brain tissue
  • Corticosteroids: Reduce inflammation, particularly effective in cases of vasogenic edema associated with brain tumors
  • Hyperventilation: Temporarily reduces intracranial pressure by constricting blood vessels
  • Sedation: Helps minimize metabolic demands on the brain

Surgical Interventions

In severe cases or when medical management is insufficient, surgical procedures may be necessary:

  1. Decompressive craniectomy: Removal of a portion of the skull to allow the brain to expand
  2. Cerebrospinal fluid drainage: Insertion of a shunt or external ventricular drain to relieve pressure
  3. Tumor resection: Removal of space-occupying lesions contributing to edema

Targeted Therapies

Treatment of the underlying cause is essential for long-term management of cerebral edema:

  • Antibiotics or antivirals for infectious causes
  • Thrombolytic therapy for ischemic stroke
  • Radiation or chemotherapy for brain tumors
  • Rehabilitation and supportive care for traumatic brain injuries

Prevention Strategies and Long-term Outlook

While not all cases of cerebral edema can be prevented, certain measures can reduce the risk of developing this condition or minimize its severity:

Preventive Measures

  • Wearing appropriate protective gear during high-risk activities (e.g., contact sports, cycling)
  • Practicing safe driving habits and using seatbelts
  • Managing underlying health conditions that increase stroke risk (hypertension, diabetes, high cholesterol)
  • Staying up-to-date with vaccinations to prevent infectious diseases that can lead to encephalitis or meningitis
  • Seeking prompt medical attention for head injuries, even if they seem minor

Long-term Prognosis

The long-term outlook for patients with cerebral edema varies significantly depending on factors such as:

  1. The underlying cause of the swelling
  2. The severity and duration of increased intracranial pressure
  3. The timeliness and effectiveness of treatment
  4. The patient’s age and overall health status

With prompt diagnosis and appropriate management, many patients can recover from cerebral edema. However, in severe cases, there may be lasting neurological deficits or long-term complications.

Emerging Research and Future Directions in Cerebral Edema Management

The field of neurology continues to advance, bringing new insights and potential treatments for cerebral edema. Ongoing research focuses on several promising areas:

Neuroprotective Agents

Scientists are investigating novel compounds that may help protect brain cells from the damaging effects of swelling and increased intracranial pressure. These neuroprotective agents aim to:

  • Reduce oxidative stress
  • Modulate inflammatory responses
  • Enhance cellular repair mechanisms

Targeted Drug Delivery Systems

Researchers are developing innovative methods to deliver medications directly to affected areas of the brain, potentially improving efficacy while minimizing systemic side effects. These approaches include:

  1. Nanoparticle-based drug carriers
  2. Implantable drug-release devices
  3. Focused ultrasound-mediated drug delivery

Genetic and Molecular Therapies

Advancements in our understanding of the genetic and molecular mechanisms underlying cerebral edema are paving the way for targeted therapies. Researchers are exploring:

  • Gene therapy approaches to modulate key proteins involved in fluid regulation
  • RNA interference techniques to suppress harmful inflammatory responses
  • Stem cell-based therapies to promote tissue repair and regeneration

Advanced Monitoring Techniques

The development of more sophisticated monitoring tools may allow for earlier detection and more precise management of cerebral edema. Emerging technologies include:

  1. Non-invasive intracranial pressure monitoring devices
  2. Advanced neuroimaging techniques for real-time assessment of brain swelling
  3. Biomarker-based tests for early detection of edema-related brain injury

As research progresses, these innovative approaches may lead to more effective treatments and improved outcomes for patients with cerebral edema.

Living with the Effects of Cerebral Edema: Patient Perspectives and Support

For many individuals who have experienced cerebral edema, the journey to recovery can be challenging and may involve long-term adjustments. Understanding the patient perspective and available support systems is crucial for comprehensive care.

Cognitive and Emotional Challenges

Survivors of cerebral edema may face ongoing cognitive and emotional difficulties, including:

  • Memory problems
  • Difficulties with concentration and attention
  • Mood swings or personality changes
  • Depression or anxiety related to their experience

Physical Rehabilitation

Depending on the severity and location of the brain swelling, patients may require extensive physical rehabilitation to regain lost functions. This may involve:

  1. Physical therapy to improve mobility and coordination
  2. Occupational therapy to relearn daily living skills
  3. Speech therapy to address communication difficulties

Support Systems and Resources

A strong support network can play a vital role in recovery and adaptation. Patients and their families can benefit from:

  • Support groups for brain injury survivors
  • Counseling services for both patients and caregivers
  • Educational resources on managing long-term effects of brain injury
  • Vocational rehabilitation programs for those returning to work

By addressing both the medical and psychosocial aspects of recovery, healthcare providers can help patients navigate the challenges associated with cerebral edema and work towards the best possible quality of life.

What Is Cerebral Edema? Symptoms, Causes, Diagnosis, Treatment, and Prevention

If you bump your elbow, you can simply apply ice and the swelling will disappear. But what happens when you hit your head and your brain starts to swell?

Cerebral edema, or brain swelling, is an increase of pressure in your head that may disrupt the blood-brain barrier. It is the body’s way of responding to trauma, stroke, or infection. Because the brain is encased in a rigid skull, increased intracranial pressure, or ICP, can prevent oxygen-rich blood from flowing to the brain, block fluids from leaving the brain, and even damage or kill brain cells.

Cerebral edema is a life-threatening condition that can cause permanent brain damage or death if not treated quickly.

Common Questions & Answers

What causes cerebral edema?

Cerebral edema is brain swelling. It happens when there’s an increased water content in or between the brain’s cells, which can lead to increased pressure in your head. Head trauma, infections, and other neurological conditions can lead to this swelling.

What are the symptoms of cerebral edema?

Headache is the most common symptom anytime the brain begins to swell. Other symptoms include dizziness, nausea, mood changes, cognitive changes, seizure, lack of coordination, numbness, and double vision.

Is cerebral edema curable?

Depending on the cause, the underlying medical condition causing cerebral edema can be reversed. Medications, tests, and careful monitoring can help treat the condition that’s causing the edema.

What is the most common type of cerebral edema?

There are four types: cytotoxic, vasogenic, interstitial, and osmotic. Strokes and traumatic brain injuries can lead to cytotoxic and vasogenic edema. Interstitial edema is often caused by the buildup of cerebrospinal fluid in the brain, and osmotic edema by electrolyte imbalances. Vasogenic is the most common type.

How long can you live with cerebral edema?

The duration of cerebral edema varies, and it depends on the cause, the individual, and the treatment plan. If not treated right away, cerebral edema can cause permanent brain damage or death.

Signs and Symptoms of Cerebral Edema

The symptoms of cerebral edema vary widely, depending on the cause, and can be extremely painful. Patient age, brain size, and edema location can also affect symptom severity. “Generally, suspected edema is not the symptom that will bring someone into the hospital,” says Ramani Balu, MD, PhD, an adjunct assistant professor of neurology at the University of Pennsylvania in Philadelphia. “People will either have a traumatic brain injury, a stroke, or experience a range of neurological symptoms before brain swelling is determined. Cerebral edema is a consequence of an underlying condition.”

Typical signs of brain swelling include:

  • Headache, which is the most common symptom anytime the brain starts to swell, Dr. Balu says
  • Dizziness
  • Nausea
  • Mood changes, such as depression, anxiety, or aggression as a result of a brain injury
  • Cognitive changes
  • Altered consciousness
  • Seizure
  • Lack of coordination
  • Intestinal obstruction (volvulus, intussusception)
  • Numbness or weakness that can be generalized or localized
  • Double vision due to inability to fully move one of your eyes in a particular direction
  • Bulging in the soft spots of an infant’s skull

Causes and Risk Factors of Cerebral Edema

Head trauma, infections, and a number of other neurological conditions can cause the brain to swell as pressure increases and compresses brain tissue. The typical causes of brain swelling include:

Traumatic Brain Injury (TBI) A TBI is a blow to the head that can result in bleeding, bruising, or swelling of the brain.

Common causes of TBI include falls, car crashes, sports, domestic violence, or combat injuries. The trauma can damage the blood-brain barrier, which then leads to abnormal fluid flow within the brain, and, in turn, swelling and increased pressure.

Infections A few different types of infections can result in brain swelling, including encephalitis and meningitis. Encephalitis is inflammation of the brain typically caused by a viral infection. It can lead to headache, fever, loss of consciousness, seizures, and more. Meningitis is an infection of the meninges that surround the brain and spinal cord. Typical causes include viral, bacterial, parasitic, or fungal infections.

Tumors A brain tumor is an abnormal growth of cells inside the brain or skull. It can compress or displace brain tissue or block cerebrospinal fluid, which can increase pressure and cause swelling.

Stroke About 87 percent of strokes are ischemic strokes caused by blockages to blood flow to the brain.

Injured brain cells typically swell and can block the drainage of cerebrospinal fluid from the brain, driving pressure even higher.

Brain Hemorrhage An intracranial hemorrhage is bleeding in or around the brain, and a hemorrhagic stroke involves the death of brain cells as a result of a ruptured or torn blood vessel in the brain. Both these conditions can cause brain swelling.

High Altitudes You can develop high-altitude cerebral edema (HACE) about two days after climbing above 4,000 meters (13,123 feet). This type of brain swelling occurs alongside acute mountain sickness (AMS), ataxia (loss of control of body movements), fatigue, and altered mental state. It can progress to a coma or death within 24 hours if not treated.

Types of Brain Swelling

There are four main types of cerebral edema. The type a person may be suffering from is dependent on the cause.

Cytotoxic This type of cerebral edema results from an accumulation of sodium and water within the cells, leading to cellular failure.

The main causes of this type of edema include traumatic brain injury, stroke, and liver failure.

Vasogenic This is caused by a disruption of the blood-brain barrier that allows fluid to leak and pressure to build inside the brain. The main causes of this type of edema include stroke, TBI, and brain tumors.

Interstitial The main cause of this type of edema is obstructive hydrocephalus, which is the accumulation of cerebrospinal fluid that widens the brain’s ventricles and increases pressure in the brain. Obstructive hydrocephalus results from a genetic defect, developmental disorder, meningitis, tumor, traumatic brain injury, or hemorrhage.

Osmotic “Cells have water inside and outside, and water can pass through their semipermeable membranes,” says Balu. “This process is called osmosis. Sometimes, there can be a buildup of electrolytes inside the cell, and this causes a high concentration of water to move into the cells.”

How Is Cerebral Edema Diagnosed?

“If a patient comes in with a TBI, stroke, or acute brain injury, there’s almost always brain swelling,” says Balu. “They’ll be immediately admitted to the ICU, and then we perform a neurological and physical exam.” According to Balu, the clinical neurological exam tests brain function and level of consciousness to see if there’s brain damage. Any slight change in level of consciousness may indicate brain damage.

“Signs we look out for include increases in intracranial pressure in the head, sleepiness, responsiveness, and problems with vision,” Balu says.

When a person is admitted to the hospital with a brain injury, sometimes neurologists will place a device directly into the brain itself to monitor intracranial pressure, Balu says.

“Next, we’ll do a scan to see what’s causing the swelling and neurological symptoms and where it’s located,” he says. “We’ll either perform a CT [computerized tomography] scan or an MRI [magnetic resonance imaging], but often we do MRIs, because they tell us more about the brain swelling and give us a picture of the type of neurological problem, whether it’s a stroke, bleeding, or tumor.”

Duration of Cerebral Edema

The duration of cerebral edema will vary depending on the individual, the cause of the brain swelling, and treatment plan.

Those who are experiencing brain swelling should be closely monitored during the first 48 to 72 hours after the injury or infection. The speed at which a patient receives treatment can affect recovery time and improve outcome.

Treatment and Medication Options for Cerebral Edema

“Once we determine what’s going on, patients will be monitored in the hospital for complications from the swelling itself, and we’ll treat the neurological condition that’s causing the edema,” Balu says. “Treatment is dictated by the type of neurologic injury.”

If the cause is cytotoxic, doctors will look to reverse the underlying medical condition first with acute treatments, Balu says — for example, by starting an intravenous (IV) delivery of hypertonic saline that increases electrolytes in the blood and pulls water out of the brain. “Same for bleeding in the brain or TBI,” he says. “In extreme cases, we’ll have our colleagues do a craniectomy, where they take a portion of the skull off to let the brain swell out.” And if a patient comes in with acute symptoms of a stroke, Balu says they first work to get blood flow to the brain.

Once cerebral edema has been diagnosed through a scan, a doctor may help relieve pressure by:

  • Keeping the hospital bed elevated 30 or 45 degrees. According to Balu, when the head is flat, it can increase pressure in the brain, so it’s best to keep the head up.
  • Maintaining normal body temperature with antipyretics
  • Maintaining a calm environment with low lighting to avoid agitation
  • Monitoring fluid and electrolyte levels
  • Prescribing pain relievers to increase comfort
  • Draining CSF fluid by inserting a catheter into the ventricle
  • Administering neuromuscular blockades
  • Offering hyperosmolar therapy

In extreme cases, your doctor may consider a craniectomy to relieve pressure. Controlled hyperventilation, high-dose barbiturate therapy, and moderate hypothermia are other treatments to reduce swelling.

Balu says an initial treatment of brain swelling is often a drug, such as:

  • dexamethasone (Decadron)
  • mannitol (Aridol, Osmitrol)
  • acetazolamide (Diamox)
  • furosemide (Lasix)
  • diuretics
  • corticosteroids

Prevention of Cerebral Edema

Preventing cerebral edema involves taking measures to protect your head. Some measures you can take to reduce the risk of edema include:

  • Using a helmet during sports or physical activities to prevent brain injury.
  • Controlling your blood pressure and cholesterol to prevent heart disease and stroke.
  • Wearing a seat belt when traveling in a vehicle.
  • Slowly ascending to high elevations to avoid HACE.
  • Avoiding smoking to reduce the oxidative and inflammatory risk of stroke

Complications of Cerebral Edema

If left untreated, cerebral edema can lead to permanent brain damage or result in a wide range of complications. These include:

  • Vision loss
  • Headaches
  • Cerebral atrophy
  • Cognitive decline
  • Altered mental status
  • Depression
  • Sleep problems
  • Epilepsy
  • Irreversible brain damage

Research and Statistics: How Many People Have Cerebral Edema?

No official statistics exist on the number of people affected by cerebral edema, but there is data on some of the primary causes of brain swelling.

According to research from the Centers for Disease Control and Prevention (CDC), about 2.87 million cases of traumatic brain injury occurred in the United States in 2014.

The CDC also reports that each year, more than 795,000 people have a stroke.

Eighty-seven percent of all strokes are ischemic, they say.

Encephalitis, another cause of cerebral edema, is rare, with 10 to 15 per 100,000 people affected each year in the United States.

Black Americans and Cerebral Edema

Certain racial and ethnic minorities are at a greater risk for some of the main causes of cerebral edema.

According to a study published in the Journal of Head Trauma Rehabilitation, the annual rate of emergency department visits for traumatic brain injuries is higher for Black Americans than for white Americans — 569 per 100,000 compared with 457 per 100,000, respectively. Black Americans also have higher rates of hospitalization due to brain injury.

While the study does not examine the underlying causes of these disparities, the researchers point to the fact that racial and ethnic minorities make up larger portions of low-income populations and are less likely to have health insurance.

In addition, the Black community faces a higher risk of stroke. According to the U.S. Department of Health and Human Services Office of Minority Health, Black Americans are 50 percent more likely to have a stroke than their white counterparts. Furthermore, Black men are 60 percent more likely to die of a stroke compared with non-Hispanic whites.

Although not all the reasons why Black Americans are at a higher risk of stroke are clear, more than two-thirds of Black Americans have at least one risk factor for stroke, including high blood pressure, diabetes, obesity, high cholesterol, sickle cell anemia, and smoking.

Related Conditions to Cerebral Edema

Evidence suggests that traumatic brain injury, one of the main causes of cerebral edema, puts people at a greater risk of Alzheimer’s disease or another form of dementia. TBI can affect a person’s cognitive functioning, including thinking and learning.

According to the Alzheimer’s Association, older adults with a history of moderate traumatic brain injury have a 2.3 times greater risk of developing Alzheimer’s than those with no history of brain injury. Those with a severe TBI have a 4.5 times greater risk.

There is no evidence to suggest that one mild traumatic brain injury is associated with dementia, but repeated mild TBIs, such as those that occur in sports like football, boxing, and hockey, has been linked to an increased risk of chronic traumatic encephalopathy, or CTE. Symptoms of CTE include memory loss, confusion, impulse control problems, impaired judgement, aggression, depression, anxiety, Parkinson’s disease, and suicidality. These symptoms can begin years or decades after the last TBI.

Resources We Love

Favorite Organizations for Information on Cerebral Edema

Brain Injury Association of America (BIAA)

BIAA is a nonprofit organization dedicated to advancing awareness, research, education, and treatment, as well as improving the quality of life for all people with brain injuries. Get the essential facts about traumatic brain injuries and read personal stories from others who have been affected.

American Stroke Association

A division of the American Heart Association, the American Stroke Association funds research, advocates for public health policies, and works with volunteers across the country to prevent strokes and help people recover from them. Sign up for their newsletter to get the latest on stroke news and connect with a trained specialist on the Stroke Family Warmline who can provide support and helpful information about stroke.

Favorite Support Groups

Support Network — American Heart Association

The American Heart Association offers a resource where you can find in-person support groups by zip code. Many groups have changed the format of their meetings to comply with social distancing and stay-at-home orders during the COVID-19 pandemic. You can also participate in online support groups and read stories from stroke survivors.

Daily Strength

Daily Strength is a free online support group for individuals with traumatic brain injury. Connect with others who understand and are going through the struggles of living with a TBI.

PINK Concussions Women’s Group

This private Facebook group is for women over the age of 25 who are suffering from a brain injury or post-concussion syndrome. Topics addressed include employment, relationships, and being a parent while living with a TBI.

Favorite Apps for Coping With Brain Injuries

Qcard

QCard was designed by a brain injury survivor for other people living with brain injuries. Free on Android and iOS, it’s designed to “outsmart forgetfulness” and allows you to set reminders, appointments, lists, and guided tasks.

Cozi

This family management organizer offers shared calendars, reminders, and grocery lists. It can be extremely helpful to stay connected with loved ones, especially if you have multiple caregivers when you’re healing from a brain injury. Cozi is free on Android and iOS.

Additional reporting by Ashley Welch and Carlene Bauer. 

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Cerebral Edema (Brain Swelling): Symptoms, Causes, & Treatment

Written by Beth Roybal

  • What Is Brain Swelling?
  • What Causes Brain Swelling?
  • What Are the Symptoms of Brain Swelling?
  • How Is Brain Swelling Diagnosed?
  • What Is the Treatment for Brain Swelling?
  • What Are the Long-Term Effects of Brain Swelling?
  • How Can I Protect my Head?
  • More

If you bump your knee, it’s likely to swell. But what if you injure your brain?

Swelling — also called edema — is the body’s response to many types of injury. It can result from overuse or infection. Usually, swelling happens quickly and is simple to treat with some combination of rest, ice, elevation, medication, or removal of excess fluid.

Your brain can also swell as a result of injury, illness, or other reasons. Brain swelling, though, can quickly cause serious problems — including death. It’s also usually more difficult to treat. As your body’s master control system, the brain is critical to overall function. Yet, the thick, bony skull that snugly protects this vital organ provides little room for the brain to swell.

 

Brain swelling goes by many names:

  • Brain edema
  • Elevated intracranial pressure
  • Cerebral edema

Swelling can occur in specific locations or throughout the brain. It depends on the cause. Wherever it occurs, brain swelling increases pressure inside the skull. That’s known as intracranial pressure, or ICP. This pressure can prevent blood from flowing to your brain, which deprives it of the oxygen it needs to function. Swelling can also block other fluids from leaving your brain, making the swelling even worse. Damage or death of brain cells may result.

Injury, other health problems, infections, tumors, and even high altitudes — any of these problems can cause brain swelling to occur. The following list explains different ways the brain can swell:

  • Traumatic brain injury (TBI): A TBI is also called a head injury, brain injury, or acquired brain injury. In TBI, a sudden event damages the brain. Both the physical contact itself and the quick acceleration and deceleration of the head can cause the injury. The most common causes of TBI include falls, vehicle crashes, being hit with or crashing into an object, and assaults. The initial injury can cause brain tissue to swell. In addition, broken pieces of bone can rupture blood vessels in any part of the head. The body’s response to the injury may also increase swelling. Too much swelling may prevent fluids from leaving the brain.
  • Ischemic strokes: Ischemic stroke is the most common type of stroke and is caused by a blood clot or blockage in or near the brain. The brain is unable to receive the blood — and oxygen — it needs to function. As a result, brain cells start to die and swelling occurs.
  • Hemorrhagic strokes: Hemorrhage refers to blood leaking from a blood vessel in the brain (intracerebral). Hemorrhagic strokes are the most common type of stroke. They occur when blood vessels anywhere in the brain rupture. As blood leaks and the body responds, pressure builds inside the brain. High blood pressure is thought to be the most frequent cause of this kind of stroke. Hemorrhages in the brain can also be due to certain medications and unknown malformations present from birth.
  • Infections: Illness caused by an infectious organism such as a virus or bacterium can lead to brain swelling. Examples of these illnesses include:
    • Meningitis: This is an infection in which the covering of the brain becomes inflamed. It can be caused by bacteria, viruses, other organisms, and some medications.
    • Encephalitis: This is an infection in which the brain itself becomes inflamed. It is most often caused by a group of viruses and is sometimes spread through insect bites. 
    • Toxoplasmosis: This infection is caused by a parasite. Toxoplasmosis most often affects fetuses, young infants, and people with damaged immune systems.
    • Subdural abscess: Subdural abscess (empyema) refers to an area of the brain becoming abscessed or filled with pus, usually after another illness such as meningitis or a sinus infection. The infection can spread quickly, causing swelling and blocking other fluid from leaving the brain.
  • Tumors: Growths in the brain can cause swelling in several ways. As a tumor develops, it can press against other areas of the brain. Tumors in some parts of the brain may block cerebrospinal fluid from flowing out of the brain. New blood vessels growing in and near the tumor can leak and also lead to swelling.
  • High altitudes: Although researchers don’t know the exact causes, brain swelling is more likely to occur at altitudes above 4,900 feet. This type of brain edema is usually associated with severe acute mountain sickness (AMS) or high-altitude cerebral edema (HACE).

Symptoms of brain swelling vary, depending on the severity and the cause. Usually they begin suddenly. You may notice any of these symptoms:

  • Headache
  • Neck pain or stiffness
  • Nausea or vomiting
  • Dizziness
  • Irregular breathing
  • Vision loss or changes
  • Memory loss
  • Inability to walk
  • Difficulty speaking
  • Stupor
  • Seizures
  • Loss of consciousness

The steps used by your doctor to diagnose brain swelling depend on the symptoms and the suspected cause. Common exams and tests used in the diagnosis include:

  • Head and neck exam
  • Neurologic exam
  • CT scan of the head to identify the extent and location of the swelling
  • MRI of the head to identify the extent and location of the swelling
  • Blood tests to check for causes of the swelling
  • Lumbar puncture

Minor cases of brain swelling due to causes such as moderate altitude sickness or a slight concussion often resolve within a few days. In most cases, however, more treatment is needed quickly.

The goal is to assure that the brain receives enough blood and oxygen to remain healthy while the swelling is relieved and any underlying causes are treated. This may require a combination of medical and surgical treatments. Prompt treatment usually results in quicker and more complete recovery. Without it, some damage may remain.

Supportive care for brain edema may include any combination of the following:

  • Hyperbaric oxygen therapy: Providing oxygen through a respirator or in a chamber helps make sure that the blood has enough oxygen in it.  
  • IV fluids: Giving fluids and medicine through an IV can keep blood pressure from dropping too low. This helps to make sure that the body — including the brain — is receiving enough blood. However, some fluids can make swelling worse. Doctors attempt to use the right amounts of the right fluids in someone with brain swelling.
  • Lowering body temperature (hypothermia): Lowering the temperature of the body and brain helps relieve swelling and allows the brain to heal. Hypothermia as a treatment for brain swelling is not widely used, however.
  • Medication: In some cases of brain edema, your doctor may start a drug to help relieve the swelling. Medication may also be given for other reasons, such as to slow your body’s response to the swelling or to dissolve any clots. The drugs your doctor gives you depend on the cause and symptoms of brain swelling.
  • Ventriculostomy: In this procedure, a surgeon cuts a small hole in the skull and inserts a plastic drain tube. Cerebrospinal fluid is drained from inside the brain, helping to relieve the pressure.
  • Surgery: Surgery may have one or more of these goals:
    • Removing part of the skull to relieve intracranial pressure; this procedure is called decompressive craniectomy.
    • Removing or repairing the source of the swelling, such as repairing a damaged artery or vein or removing a growth

 

It’s common to have lingering effects from brain swelling. The problems you notice depend on the severity as well as the location of the injury. Symptoms may be noticed with any of the following:

  • Sleeping
  • Thinking and attention skills
  • Headaches
  • Depression
  • Communication skills
  • Movement
  • Urinary incontinence 

Your health care team is available to help you deal with these challenges. While some problems may continue to diminish over time, others may require ongoing treatment.

To protect the brain, keep these tips in mind as you go about your daily activities:

  • Use a helmet when biking, skating, playing contact sports, or performing other activities in which you might fall and hit your head.
  • Wear seat belts properly when driving or riding in vehicles.
  • Make sure you are doing all you can to control high blood pressure and heart disease.
  • Avoid smoking.
  • When traveling to high elevations, take your time — allow your body to adjust to the altitude.

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Cerebral edema – causes, symptoms, signs, consequences, diagnosis, treatment, prognosis

Signs of cerebral edema occur in a life-threatening emergency. In this condition, fluid is rapidly accumulating in the brain tissues, especially the glial (supporting) and intercellular space. The volume of the brain increases, and since the skull cannot expand, pressure increases sharply in its cavity, and intracranial hypertension develops.

Features of cerebral edema

Cerebral edema is an incomplete term, since two processes occur simultaneously: edema and swelling of the medulla. With edema, the cells move apart and are squeezed by the accumulating fluid, which disrupts the transport of oxygen and intracellular metabolic processes. Swelling increases the volume of the cells themselves. Edema and swelling do not occur in isolation (separately), these processes are interconnected and always occur simultaneously. Medical assistance must be provided immediately, otherwise it is impossible to save the patient.

It should be noted that other organs of the human body also swell during illness. However, in other organs it is not so dangerous. Even swelling of the bone marrow can lead to paralysis or loss of vision, which eventually disappear. The brain is the main control organ of the body, and any damage to it is life-threatening.

The contents of the cranium consists of three types of tissues, their percentage is as follows:

  • brain substance or parenchyma – up to 85%;
  • cerebrospinal fluid or cerebrospinal fluid – up to 9%;
  • blood – up to 6%.

In this case, the amount of the entire fluid (extra- and intracellular, blood, cerebrospinal fluid) is about 1200 ml. This fluid is in dynamic equilibrium, constantly produced and absorbed up to 600 ml daily. All brain tissues are incompressible, therefore, they are quickly damaged when intracranial pressure or ICP increases (the norm is from 7 to 15 millimeters of water column). A slight increase in ICP can be compensated by an increase in absorption, but this has its limits. An increase in ICP leads to compression of the veins, and absorption stops.

The condition is not a disease, but a complication of other diseases or injuries.

Causes of cerebral edema

The brain swells in many conditions:

  • trauma;
  • abscess;
  • tumor;
  • meningitis;
  • encephalitis;
  • oxygen starvation;
  • stroke;
  • infections;
  • intoxication;
  • widespread body burns;
  • malignant hypertension.

More often than others, cerebral edema occurs during and after a stroke, as well as trauma. Regardless of the cause, the mechanism of edema and swelling is the same. There are local and diffuse edema. Local, or local, develops around a small injury: a tumor, an abscess, a heart attack (blockage by a blood clot), a bruise site. Diffuse develops in systemic diseases (intoxication, malignant hypertension, burns of the body) and covers the entire brain.

Cerebral edema in adult or elderly patients develops in severe diseases of the internal organs:

  • heart failure;
  • anaphylactic shock;
  • diabetes mellitus;
  • liver and kidney failure;
  • infections – toxoplasmosis, influenza;
  • poisoning with external poisons;
  • status epilepticus.

There is swelling of the brain after surgery to remove tumors and hematomas, in chronic alcoholics due to increased vascular permeability, in lovers of high-mountain sports, after violating the rules of gradual acclimatization to a reduced oxygen content in the mountain air.

Cerebral edema in children occurs with birth trauma, protracted labor, tight entanglement of the umbilical cord, with severe toxicosis during pregnancy. Unclosed fontanel sutures can to some extent compensate for swelling, but are dangerous for damage to the medulla.

Edema of the spinal cord of the spine is a mandatory (universal) reaction of tissues to any injury. All pathological conditions (trauma, surgery, rupture of the hernial protrusion, demyelinating diseases) are accompanied by swelling. The most dangerous period is the first 3-5 days. Mortality and consequences largely depend on the level of the lesion, the most dangerous in the cervical region.

Symptoms of cerebral edema

The clinical picture consists of three syndromes:

  • cerebral;
  • focal and stem;
  • dislocations (displacements) of brain structures.

Cerebral syndrome reflects an increase in ICP. The patient is lethargic or stunned, may complain of severe arching headache, persistent hiccups, nausea and vomiting, photophobia. There are oculomotor disorders, especially double vision, increased blood pressure, and the frequency of respiration and pulse slows down. Muscle tone increases, the head cannot be bent to the sternum. Eye movements are painful, as are the exit points of the cranial nerves on the face.

Focal symptoms appear when the process spreads to the cortex and subcortex, stem symptoms – to the brain stem. Edema of the hemispheres is manifested by narrowing or loss of consciousness, generalized convulsions. Damage to the subcortex and deep structures is manifested by psychomotor agitation, excessive movements (hyperkinesis), grasping reflexes. The pose of the “pointing dog” is characteristic – on its side with an unbent head with legs and arms bent at the knees and pressed to the body. Compression of the trunk is manifested by periodic non-rhythmic breathing, miosis (sharp constriction of the pupils), a drop in blood pressure, and cardiac arrhythmia.

How long they live with cerebral edema depends on whether it is possible to stop the growth of the process, this period is calculated in days or even hours.

Displacement of brain structures is manifested by signs of separation of the cortex and subcortical structures: fever above 40 ° C, lack of consciousness with “floating” eyeballs and divergent strabismus. This is an irreversible state.

In children, the condition is manifested by constant screaming and crying, bulging of a large fontanel, generalized convulsions. Without medical attention, breathing stops quickly.

Diagnosis of cerebral edema

This is an emergency condition, which the doctor has a few minutes to recognize. Diagnosis is based on clinical signs; if the hospital is well equipped, a CT scan is possible.

Lumbar puncture is contraindicated because of the risk of wedging the brainstem into the foramen magnum.

The patient is immediately transferred to the intensive care unit, urgent blood tests are performed, especially the acid-base balance is monitored.

Treatment of cerebral edema

It is carried out individually in accordance with the developing situation, counteracting all emerging violations. First of all, dehydration treatment is performed to remove excess fluid. Various types of diuretics and decongestants are injected intravenously – mannitol, loop diuretics. Substances with neuroprotective properties are used: magnesium sulfate, glucose solution. This helps to prevent the negative consequences of cerebral edema and save the patient’s life.

Give pure oxygen to breathe or transfer the patient to mechanical ventilation, use local head cooling. Metabolic processes are improved with the help of cortexin, citicoline and antioxidants. Cell membranes are stabilized with glucocorticoid hormones.

After stabilization of the state, reduction of hyperthermia, with stable blood pressure, pulse and respiration, they treat the underlying disease: trauma, tumor, hematoma, infarction.

The prognosis for cerebral edema depends on many factors: age, underlying and concomitant diseases, genetic stability, speed of medical care. The outcome can be either a complete recovery or the formation of focal neurological symptoms or a psychoorganic syndrome with a gross decrease in intelligence.

To prevent such a formidable complication, it is necessary to consult a doctor in case of any, even seemingly minor, health disorder. Particularly noteworthy are persistent, growing headache, double vision, unsteadiness. When these signs appear, you should immediately contact a neurologist.

The author of the article:

Markelov Gleb Vladimirovich

neurologist, online consultations

work experience 7 years

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