Management of Cerebral Edema
Derek A. Bruce MB, ChB1
1 Associate Neurosurgeon, Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, Associate Professor Neurosurgery and Pediatrics, University of Pennsylvania School of Medicine
Although no new drugs have become available for improved treatment of cerebral edema, the increased understanding of the pathophysiology of the edematous process has led to more rational approaches to therapy, both in patients with cytotoxic intracellular brain edema and those with extracellular vasogenic brain edema. In the unconscious patient, the addition of ICP monitoring is invaluable in helping in the selection of therapy and in measuring the results of therapy.
The various therapies available have been reviewed and a logical approach to treatment suggested. In patients with extracellular edema, it is likely that intensive treatment will result in good recovery. In patients with intracellular edema, the ultimate factor deciding outcome is the etiology of the metabolic disturbance rather than the cerebral edema itself. Until there are drugs that specifically reverse the metabolic defacts produced by anoxia of ischemia, it seems unlikely that intensive care in this group of patients will result in a dramatically improved outcome.
