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Cerebral edema: types, symptoms, causes and treatment

Cerebral edema: types, symptoms, causes and treatment

July 19, 2024

If someone tells us that they have fluid retention, we are probably thinking of a person with legs or some part of the body inflamed and swollen. Said in this way may seem somewhat irrelevant, easily treatable and can hardly be a nuisance, as in fact this is in many cases. However, this fluid retention or edema can be very dangerous depending on where it occurs. Because it is not the same to have fluid retention in the legs or ankles than to have it in organs such as the lung.

One of the most serious and dangerous situations that can occur in this sense is the presence of cerebral edema, which can even become a cause of death .

  • Related article: "Types of edema (according to their causes and main symptoms)"

Defining the concept of edema

Before talking about cerebral edema itself, it is necessary to understand first of all what we refer to when we speak of the term edema. It is understood as such the existence of a soft tissue swelling or inflammation due to the accumulation of fluid in or between your cells, due to imbalances in the amount of interstitial fluid that leaves or enters the cells.

This inflammation can have a wide variety of causes and be located in almost all types of soft tissues of the body, and may have repercussions of different consideration depending on the type of tissue affected.

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Cerebral edema: main symptoms

One of the locations where you can get an edema, as well as one of the most dangerous, is in the brain tissue. In cerebral edema we find an increase and accumulation of fluid between brain cells that generates an inflammation with sufficient magnitude to cause clinical symptoms.

This inflammation is so serious in this case because the brain does not float in a vacuum , but it is surrounded by a bone structure that protects but at the same time limits it: the skull. The accumulation of fluid can cause a compression of the brain mass against the walls of the brain, which can cause neurons to die.

Likewise, greatly increases the level of intracranial pressure by not maintaining the usual electrolyte balance, which can also alter and cause cellular degeneration. Finally, the compression can affect the blood vessels, preventing oxygen from reaching one of the regions of the brain and ending up drowning.

Depending on the compressed brain regions the symptoms can vary greatly. Dizziness, fatigue and weakness usually appear, as well as a possible alteration of the level of consciousness, headaches, gastrointestinal symptoms such as nausea and / or vomiting or perceptual alterations. The breathing can be accelerated and convulsions can even appear.

Related to the alterations of conscience, in severe cases the patient's coma or even death may be caused if the nuclei responsible for maintaining the heart and respiratory rate are compressed. In some cases it can generate a herniation of the brain or the permanent loss of relevant functions.

In addition to these symptoms, the presence of cerebral edema can lead to death or the appearance of some kind of physical, mental or sensory disability , being able to alter to a large extent the habitual functioning of the person either temporarily or permanently.

Types of cerebral edema

There is no single type of cerebral edema , but we can find different types depending on where and why the imbalance and the accumulation of liquid occurs. And it is that the liquid can accumulate both inside the cells and in the extracellular space.

1. Cytotoxic edema

In this type of edema the swelling occurs when fluid accumulates inside the cells themselves, having captured these abnormally an excessive amount of interstitial fluid . It is usually caused by a malfunction of the sodium / potassium pumps and the channels through which the fluid enters and leaves the cells. We are faced with a problem of regulation of cellular metabolism and maintenance of homeostasis. The consumption of some toxic element can be one of its causes.

2. Vasogenic edema

It is considered as such to that edema that occurs as a result of an increase in the permeability of the nervous system, due to the breakdown of the blood-brain barrier. Generally we find that blood plasma penetrates the parenchyma or extracellular space that surrounds nerve cells and accumulates in it. It is the most common type of cerebral edema.Tumors, strokes and traumatic brain injuries tend to be some of the most common causes.

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3. Hydrocephalic or interstitial edema

Edema generated by obstruction of the channels through which the cerebrospinal fluid circulates, causing the cerebral ventricles to swell or areas near the blocked area. It appears in hydrocephalus .

  • Related article: "Hydrocephalus: causes, types and treatments"

Possible causes

There are a large number of possible causes for the existence of cerebral edema. Some of the most frequent are the following.

1. Cranioencephalic trauma

One of the causes that can be easier to identify is the one that has to do with the existence of a trauma to the head. This blow causes the rupture of blood vessels to occur , flooding the brain with blood. When trying to absorb excess fluid, the cells would become inflamed.

2. Stroke

The existence of a cerebral hemorrhage or the blockage of the cerebrovascular system is one of the most known causes of cerebral edema. And is that these accidents would generate that either extravasaran fluids directly inside the brain or that the nerve cells died and broke, causing fluid accumulation.

3. Viral or bacterial infections

Another possible cause of a cerebral edema can be found in the existence of an infection. The cells are damaged and break, generating an imbalance in the brain fluid level. Within this group of causes we find very different diseases, from meningitis to Reye's syndrome .

  • Maybe you are interested: "Meningitis: causes, symptoms, treatment and prognosis"

4. Tumors

The appearance of neoplasms, whether benign or malignant , it can generate compression of blood vessels or block the passage of cerebrospinal fluid, which can have as a consequence the appearance of fluid accumulation in some areas of the brain.

5. Hypoxia derived from altitude

This type of edema occurs in subjects such as climbers and divers. The main cause is the existence of a sudden variation of the atmospheric pressure before a rapid ascent : before the lack of oxygen the organism tries to dilate the arteries and veins of the nervous system, but if this situation is prolonged or the change is generated very fast said dilation will generate homeostatic difficulties that will culminate with the accumulation of liquids in the brain.

6. Hyponatremia

Disorder that occurs in the absence of sufficient level of sodium in the blood, which the body tries to compensate by causing an increase in the entry of fluid inside the cells.

7. Intoxication

Consumption of some toxic or poisoning it can generate alterations in the nervous system that cause the existence of imbalances in the intra- or extracellular fluid levels.


The treatment of cerebral edema is essential and it requires a fast professional action in order to avoid the death or the appearance of irreparable damages in the patient.

The first step that should be used is the elimination of the accumulation of fluid and the reduction of inflammation, being essential to control vital signs at all times. The application of artificial respiration mechanisms may be necessary to maintain a constant and sufficient flow of oxygen.

In cases in which the patient's life is in danger, it is usual to use surgery immediately to control the level of inflammation by draining the fluid, or the resection of part of the skull to release and reduce intracranial pressure. Once the patient is stabilized, it is necessary to analyze what has caused the problem in order to treat its causes.

Also, it has been proven that the induction of controlled hyperventilation decreases the formation of cerebral edema. However, it must be very controlled, since depending on how much and how long it is carried out, it can have very harmful effects.

Both in this and in other cases where surgery is not used, the use of different drugs is common. For example, the application of corticosteroids is very frequent in order to reduce the level of intracranial pressure in those cases in which the problem is not of cytotoxic or hemorrhagic origin. Osmotics and diuretics can also be used to facilitate the expulsion of fluids.

Bibliographic references:

  • Cecil, R. (2015). Cecil medicine (24rd ed.). Philadelphia, Philadelphia: Saunders Elsevier.
  • Jaramillo, J.J. (1997). Fluid management in the neurosurgical patient and with traumatic brain injury. Memories XXIII, Annual Course of Updating in Anesthesiology. Mexican Society of Anesthesiology.
  • Jha, S. K. (2003). Cerebral edema and its management. Medical Journal Armed Forces India, 59 (4), 326-331.
  • Kasper, D. (2015). Harrison's principles of internal medicine (19th ed.).New York, New York: McGraw-Hill, Medical Pub. Division.
  • Milhorat, T.H .; Johnson, W.D .; Dow-Edwards, D.L. (1989). Relationship between edema, blood pressure, and blood flow following local brain injury. Neurol. Res.; 11: 29
  • Renkin, E.M. (1994) Cellular aspects of transvascular exchange: a 40-year perspective. Microcirculation 1 (3): 157-67.

"Cerebral Edema in Diabetic Ketoacidosis" by Michael Agus, MD for OPENPediatrics (July 2024).

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