Update: December 2018
Cerebral edema is the result of interconnected
result of diseases or pathological conditions.
it осложнение, в зависимости от степени тяжести, может остаться
imperceptible and pass without a trace, for example, with a slight concussion
brain (symptoms). Значительно чаще effects отека
brain – it is further severe complications in the form of:
- changes in mental and mental activity
- visual impairment
- coordination functions of the body that cause
- often brain swelling is fatal.
What is brain swelling?
The essence of the accepted definition of this state is
nonspecific reaction of the whole organism in response to exposure
severe damaging factors. The latter are the cause:
- disorders of microcirculation in the brain;
- lack of oxygen transport to the brain, especially when combined with
excessive accumulation of carbon dioxide in the blood;
- нарушения водно-электролит
ного, белкового и
energy types of metabolism with accumulation in nerve cells
- нарушения кислотно-щелочно
го состояния крови;
- changes in osmotic (electrolyte) and oncotic
(protein) plasma pressure.
ATсе эти причины приводят к набуханию и отеку мозга. With отеке
there is a violation of the permeability of the walls of the capillaries and the release of liquid
pieces of blood into the surrounding tissues. With набухании же из-за разности
oncotic pressure water molecules flow directly into
brain nerve cells through their membrane. Here they are connected
intracellular proteins and cells increase in volume.
However, most authors of scientific articles consider
swelling as one of the stages of edema leading to bulky
increase in the brain. it приводит к его сдавлению и смещению
(dislocations) around its axis inside a closed space,
limited to the bones of the skull.
The spread of cerebral edema causes infringement
underlying structures (medulla) in large occipital
hole. AT нем находятся жизненно важные центры — регуляции
Withзнаки отека мозга клинически проявляются в нарушении
functioning of nerve cells and brain centers even before
there comes a complete damage to their structures, which is already possible
identify using modern research methods.
ATиды и причины отека
There are two types of brain edema:
- Local, или регионарный отек, то есть ограниченный
a certain area surrounding the pathological formation in
brain tissues – abscess, tumor, hematoma, cyst.
, распространенный на весь мозг. is he
develops with traumatic brain injury, asphyxiation, drowning,
intoxication, loss of large amounts of protein in the urine during
various diseases or poisoning, with hypertensive
encephalopathy resulting from severe forms of elevated
blood pressure, and other disorders.
ATо многих случаях, за исключением черепно-мозговой травмы или
asphyxia (suffocation) detection of cerebral edema is difficult on
background symptoms of other diseases and pathological conditions.
Начало development отека можно предположить, когда признаки основного
diseases are diminishing or not progressing, and neurological
symptoms on the contrary appear and grow.
The main causes of cerebral edema:
- traumatic brain injury, concussion and contusion of the brain, asphyxia
vomit in alcoholic coma or after hanging, stenosis
larynx in children with acute respiratory infection (see treatment
laryngitis in a child);
- subdural hematoma formed under the cerebral cerebral
shell as a result of mechanical action without breaking
the integrity of the bones of the skull;
- опухоли головного мозга, субарахноидально
е (под паутинную
- hemorrhage that often occurs as a result of a stroke
high blood pressure (see the first signs of a stroke,
effects ишемического инсульта);
- acute infectious diseases – influenza, meningitis, encephalitis,
including – severe child infections – an epidemic
parotitis, measles, scarlet fever, chicken pox;
- gestosis of the second half of pregnancy – severe nephropathy,
preeclampsia and eclampsia;
- diseases involving convulsive syndrome –
hyperthermia in children (high temperature) in infectious
diseases, heat stroke, epilepsy;
- severe diabetes mellitus, especially with
го состояния, острая и хроническая
почечная, печеночная или почечно-печеночн
- severe allergic reactions and anaphylactic shock;
- poisoning with drugs, chemical poisons and
- swelling of the brain in newborns as a result of entanglement
umbilical cord, prolonged labor, severe gestosis in the mother (see preeclampsia
during pregnancy), birth injury to the child’s brain.
In addition, brain swelling almost always occurs after operations on
the skull. Sometimes – after operations performed under the spinal cord or
epidural anesthesia or accompanied by large blood loss,
due to a pronounced and prolonged decrease in blood pressure,
with excessive intravenous saline or hypotonic
solutions during surgery, due to the difficulty of tracheal intubation with
the purpose of carrying out artificial ventilation or inadequacy itself
ventilation and anesthesia.
Symptoms of cerebral edema
Depending on the duration of the disease, localization
symptoms of cerebral edema may be different. Local,
limited swelling is manifested by cerebral symptomatology or
single signs characteristic of this part of the brain. With
increasing or initially generalized edema but slowly
there is a gradual increase in the number of symptoms,
meaning damage to several parts of the brain. All symptoms conditionally
divided into three groups:
Withзнаки повышенного внутричерепного давления
- drowsiness and lethargy
- sometimes alternating psychomotor agitation
- depression of consciousness gradually increases, and nausea and
- dangerous convulsions – clonic nature (short-term
sweeping muscle contraction of the limbs and face),
tonic (prolonged muscle contraction giving individual parts
тела необычное положение) и клонико-тоническ
ие, приводящие к
increase in swelling of the brain.
- The rapid increase in intracranial pressure causes
headache, repeated vomiting, movement disorder
- Cerebral edema in children (infants), children under 1 year
leads to an increase in head circumference (see increased
intracranial pressure in infants), and after closing the springs –
to their disclosure due to the displacement of the bones.
The appearance of diffuse (diffuse) neurological symptoms
This is a reflection of the growth of the pathological process,
carrying the risk of developing coma with swelling of the brain. it
caused by involvement in the swelling in the beginning of the cerebral cortex, and then
subcortical structures. In addition to impaired consciousness and the transition to
a coma arise:
- генерализованные (распространенны
- psychomotor agitation between seizures
epileptic type occurring with a predominance of elevated
- pathological protective and grasping reflexes
The group of the most terrible symptoms
They are associated with a further increase in cerebral edema, dislocation
(offset) of its structures, with their wedging and pinching in large
occipital orifice. These features include:
- Coma of varying degrees.
- Hyperthermia (up to 40 degrees or more) that does not respond
снижению при применении жаропонижающих и сосудорасширяющи
drugs. Slightly reduce the temperature sometimes only
the use of cold in the area of large vessels or general
- There are different sizes of pupils and the absence of their reaction to
light, cross-eyed, “floating” eyeballs, unilateral paresis and
односторонние судорожные сокращения мышц-разгибателе
heart rhythm disturbances with a tendency to decrease in frequency
heart contractions, lack of pain and tendon
- If the patient is not given artificial lung ventilation, then
the frequency and depth of breathing initially increase, the rhythm is disturbed
breathing followed by stopping and stopping the heart
On an outpatient basis, diagnosis of brain edema is sufficient.
difficult because this state is not special
specific neurological symptoms. Early stages of swelling
the brain may be asymptomatic or asymptomatic.
The diagnosis is established on the basis of the symptoms of the main
the disease or injury that caused the edema, and the results
eye fundus studies.
With подозрении на развитие отека мозга пациента следует
deliver to the intensive care or neurosurgical department. AT
the conditions of the hospital solves the question of holding lumbar
puncture, angiography. MRI and CT are informative, which
help identify swelling, assess its severity and
Consequences of brain edema in adults and children
The earlier such pathology will be detected and rendered
intensive adequate medical care the higher the chances of
recovery. AT условиях стационара производится восстановление
blood supply to the brain, liquorodynamics, dehydration therapy,
the prognosis is largely determined by the severity of the disease.
Since with small perifocal edema it is possible to complete
recovery, and with the development of cystic atrophic processes in
brain tissue can only achieve partial recovery
functions. When only the main disease is treated,
accompanied by swelling of the brain, then recovery is possible
not in all cases and high risk of death.
The success of the treatment and the consequences depend on the severity of the disease,
edema of the brain and the degree of development of the edema itself, which
may be resolved by complete recovery. AT более severe cases
- When edema develops in the medulla, where are
major life support centers of the body, the consequence of edema
головного мозга может стать — нарушение дыхания, convulsions,
epilepsy, circulatory disorders.
- Even after treatment, the patient may continue to
remain elevated intracranial pressure (symptoms), which
greatly affects the patient’s quality of life, as it is accompanied by
headaches, disorder of consciousness, loss of orientation
human in time, reduced social communication skills,
appears lethargy, drowsiness.
- Infringement of the brain stem, as well as its displacement, is very dangerous;
threatened stop breathing, the development of paralysis.
- After treatment and rehabilitation course, many patients remain
adhesive processes between the membranes of the brain, in the ventricles of the brain or
ликворных пространствах, что также сопровождается головными
pains, neuropsychiatric disorders and
- With продолжительном отеке головного мозга без лечения
dysfunction of the brain may later manifest, decrease
human mental abilities.
Children may also recover fully or:
- development of cerebral palsy and hydrocephalus (see elevated
intracranial pressure in infants)
- epilepsy (see symptoms and treatment of epilepsy) and disorders
functions of internal organs
- speech disorders and motor coordination
ая неустойчивость и задержка умственного
Cerebral edema is a serious, often very severe pathology,
which requires further observation and treatment of adults in
neuropathologist, psychoneurologist, and children – a neuropathologist together
with a pediatrician. The duration of observation and treatment after suffering
cerebral edema depends on the severity of residual