Emergency Neurological Conditions

Cerebral edema and intracranial hypertension

Brain swelling, or cerebral edema, is caused by conditions that cause swelling of brain tissue. Brain swelling can be very dangerous because it can result in an increase in brain pressure or can result in pressure and injury to adjacent brain structures. Brain swelling can result from stroke, bleeding or tumor. Sometimes brain swelling causes a rise of pressure inside the brain. This condition is called intracranial hypertension.

There are multiple treatment options for the patient suffering from brain swelling. Brain swelling itself is treated by “hyper-osmolar” medications. These medications reduce swelling by drawing fluid away from the swollen areas of the brain. These medications include manitol and hypertonic saline, a concentrated salt solution. Draining normal fluid from the brain, called cerebrospinal fluid, may control brain pressure. This is done by placing a catheter through the skull and into the fluid filled spaces of the brain. This is called a ventriculostomy. In some cases, surgery may have to be performed to open the skull and permit swelling. This is done by removing part of the cranium. Later, when brain swelling is resolved, the cranium is replaced. This is sometimes accompanied by a lobectomy, or removal of non-essential brain to create more room for swelling. In some cases the brain is put to sleep in order to reduce brain pressure associated with swelling. This is called an induced coma and is achieved by giving strong medications, called barbiturates, which nearly silence electrical activity in the brain.

When intracranial hypertension is caused by brain tumors, medications called “steroids” can be effective. Steroids work by relieving inflammation in the brain related to tumor. The definitive method for treating intracranial hypertension or cerebral edema caused by a brain tumor is surgery to remove the tumor.

In some cases intracranial hypertension is caused by bleeding in the brain, called cerebral hemorrhage. When cerebral hemorrhage causes uncontrolled swelling, or intracranial hypertension, surgery is performed. Surgery usually involves removing a small portion of the skull and sucking out the blood clot from within the brain using very small and delicate instruments. When the surgeon expects that swelling will persist, the bone is left off of the skull, to be replaced at a later time.