Edema of the brain: causes, symptoms, diagnosis, treatment

Edema of the brain is a universal nonspecific reaction of the brain characterized by disturbances of water-ion equilibrium in the system of "neuron-glia-adventitia".

[1], [2], [3], [4]

Causes of cerebral edema

Edema of the brain can be accompanied by neurotoxicosis, neuroinfections, brain injuries, metabolic disorders. The main causes of brain swelling are hypoxia and hypoxemia, especially in combination with an increase in the level of carbon dioxide. An important role is played by metabolic disorders (hypoproheinemia), ionic equilibrium, and allergic conditions. Children in the heart of cerebral edema are hypertension and fever, because they contribute to vasodilation.

Many authors describe edema-swelling of the brain as a universal nonspecific reactive process, the clinical expression of which are cerebral disorders. The diverse pathogenetic factors leading to edema-swelling of the brain can be reduced to two main: vascular and tissue. With increasing vascular permeability, interstitial edema develops, with parenchymal damage - brain swelling.

Edema of the brain is the accumulation of free fluid in the brain tissue, intercellular space.

Brain swelling is characterized by increased water binding by biocolloids of the structural elements of the brain. The essence of the parenchymal mechanism is the occurrence of metabolic shifts that promote the accumulation of water in biocolloids.

The pathogenetic scheme of the edema-swelling of the brain is as follows:

• toxic or hypoxic effects on the receptors of the vascular plexus of the brain and increased vascular permeability lead to hyperfrozen cerebrospinal fluid;
• the growth of intracranial pressure to a level higher than the arterial pressure leads to hypoxia of the brain;
• compression of the brain stem is accompanied by depression of the reticular formation and its activating influence on the cerebral cortex, a loss of consciousness is observed; -
• hypoxia leads to energy deficiency, metabolic disorders in brain cells, acidosis, accumulation of metabolites, various BAS (histamine, kinin, adenosine, etc.), further damaging the brain tissue;
• catabolism of tissues is accompanied by an increase in the osmotic potential of tissue colloids and the amount of water associated with them. The disintegration of tissues, the accumulation of metabolites are accompanied by an increase in the osmotic pressure inside the cells and in interstitium, by the inflow of free water to them.

[5], [6], [7], [8], [9], [10], [11], [12], [13], [14]

Symptoms of cerebral edema

On the development of cerebral edema in children indicate symptoms of increased intracranial pressure (manifested in the form of cerebral syndrome). The increase in the severity of neurologic changes and the degree of impairment of consciousness, as well as the dislocation syndrome of brain structures. On the background of clinical manifestations of the underlying disease, weakness, lethargy, and headache increase. Pareses and paralysis appear or intensify, the edema of the nipple of the optic nerve occurs. As the swelling spreads, convulsions develop, lethargy, drowsiness, violations of the cardiovascular system and respiration, pathological reflexes appear.

Edema of the brain in infants is characterized by an arousal, headache, a piercing "brain" cry, non-curable hyperthermia, bulging of a large fontanel, the appearance of rigidity of the occipital muscles, congestion, coma and convulsions. The first signs of the development of cerebral edema in Reye's syndrome and acute renal failure include the occurrence of decerebral rigidity with dilated pupils.

With the syndrome of dislocation of the brain structures, the symptoms of the temporomandibular or occipital wedging of the brain develop: the appearance of convergent strabismus, anisocoria, and aggravation of violations of vital functions. For compression of the midbrain, oculomotor crises are characteristic with pupil dilatation and fixation of the eye, increased muscle tone, tachycardia, fluctuations in blood pressure, hyperthermia. When the trunk is compressed, loss of consciousness occurs, mydriasis, anisocoria, vomiting are observed. Symptoms of cerebellar infringement: bradycardia, bradypnoea, vomiting, dysphagia, paresthesia in the shoulders and arms, stiff neck, arising before the appearance of other symptoms, and stopping breathing.

Diagnosis of cerebral edema

The likelihood of developing cerebral edema should be taken into account in any unclear loss of consciousness, convulsions, hyperthermia, especially against a background of any disease. Repeated, even short-term, hypoxic conditions are essential. Diagnosis of edema is assisted by CT or MRI of the brain, as well as radiography of the skull. Spinal puncture should be performed only in a hospital.

[15], [16], [17], [18]

Emergency medical care for edema of the brain

When the brain is swollen, children undergo a revision of the upper respiratory tract and ensure their patency. Give 50% oxygen through a mask or nasal catheter. Ventilation in the mode of moderate hyperventilation is performed in a hospital. Assign mannitol intravenously every 6-8 hours, followed by the administration of furosemide (lazix). To reduce intracranial pressure, magnesium sulfate can be used.

To ensure neuroplegy, reduce the need for oxygen and with convulsive syndrome use diazepam, droperidol or sodium oxybate (sodium oxybutyrate). It is recommended to administer dexamethasone and anesthesia with barbiturates - hexobarbital (hexenal), phenobarbital. Infusion therapy is performed in the volume of daily requirements for liquid. To improve microcirculation in the brain intravenously drip pentoxifylline (trental). On 2-3 days of treatment of edema of the brain, but not in the acute period, it is possible to prescribe piracetam.

When transporting a patient with cerebral edema and acute increase in intracranial pressure should lie on the back with an elevated head end.

[19], [20], [21], [22], [23], [24], [25]