Brain edema
Introduction
Introduction to brain edema Cerebral edema refers to the pathological phenomenon in which the water in the brain increases and the volume of the brain increases, which is the response of brain tissue to various pathogenic factors. Can cause intracranial hypertension, damage brain tissue, clinically common in nervous system diseases, such as craniocerebral trauma, intracranial infection (encephalitis, meningitis, etc.), cerebrovascular disease, intracranial space-occupying diseases (such as tumors), Seizures and systemic diseases such as toxic dysentery, severe pneumonia. basic knowledge The proportion of illness: 0.0035% Susceptible people: no special people. Mode of infection: non-infectious Complications: cerebral palsy, headache
Cause
Causes of brain edema
Environmental factors (15%)
Systemic poisoning caused by lead poisoning or other causes, often complicated by diffuse brain edema. Various causes, systemic or localized cerebral metabolic disorders, cause brain edema. Including electromagnetic damage effects such as microwave, infrared, X-ray, gamma ray, beta ray, fast neutron, etc.
Damage factor (20%)
All kinds of craniocerebral injury, directly or indirectly caused by brain contusion and laceration can cause cerebral edema, and intracranial hematoma, so that local brain tissue compression can also cause brain edema.
Disease factor (20%)
The tumor causes the surrounding brain tissue to be compressed or blocked by cerebral venous return, elevated venous pressure, intracranial congestion, cerebrospinal fluid circulation machine absorption disorder, and tumor biotoxicity, so that the brain tissue around the tumor is affected, and the blood-brain barrier is damaged or destroyed. The blood vessel wall is permeable to brain edema and produces localized cerebral edema. Intracranial diffuse inflammation caused by encephalitis, meningitis, ventriculitis, brain abscess and sepsis often precedes different degrees of cerebral edema, which is related to the toxicity and extent of pathogenic microorganisms.
Brain Injury
Skull sag fracture, compression on the brain tissue, or fracture of the fracture piece directly into the brain tissue, cerebral edema in the affected area, blast shock wave impact on the chest, or the chest directly directly squeezed, making the superior vena cava pressure sharp Elevated, the pressure spreads to the brain and impacts the brain tissue, causing extensive diffuse punctiform hemorrhage of the capillaries in the brain tissue, increased capillary permeability, often diffuse brain edema, diffuse axonal damage of the brain, can continue Severe diffuse brain edema.
Intracranial space-occupying lesion
Brain edema associated with primary malignant tumors of the brain is particularly pronounced. Brain metastases such as lung cancer and choriocarcinoma, whether single or multiple, have severe cerebral edema around the lesion.
Cerebrovascular disease
Internal carotid artery or cerebral arterial thrombosis or embolism, brain fat embolism, reduce or interrupt arterial blood flow, causing acute cerebral insufficiency and cerebral infarction in the arterial blood supply area, and secondary localized or extensive cerebral edema, brain Aneurysm or arteriovenous malformation rupture, subarachnoid hemorrhage, intraventricular hemorrhage and cerebral vasospasm, secondary to cerebral edema. Cerebral hypoxia, status epilepticus, chest trauma, dyspnea or asphyxia caused by different causes, cardiac arrest, prolonged hypotension, shock, high altitude hypoxia, carbon monoxide poisoning and other pulmonary encephalopathy, leaving the brain in a deficiency The oxygen state is accompanied by cerebral edema.
Prevention
Cerebral edema prevention
Cerebral edema is a secondary pathological process. Systemic diseases such as severe brainwashing vascular disease, respiratory disease, liver disease, shock, poisoning and metabolic diseases cause changes in the body's environment, causing ischemia and hypoxia of the brain tissue. Circulation and brain cell metabolism disorders may cause brain edema. So it is a matter of universal significance. In neurosurgery, encephalopathy such as craniocerebral injury, intracranial space-occupying lesions, inflammation, cerebrovascular disease, cerebral parasitic diseases, congenital brain diseases, etc., often secondary edema, secondary edema, often related to The intracranial disease process and prognosis are more important. In the field of neurosurgery, if you can know more about the mechanism of brain edema and prevent and treat cerebral edema, you can achieve better results in the treatment of intracranial diseases.
Complication
Cerebral edema complications Complications, cerebral headache
Cerebral edema increases intracranial pressure, and increased intracranial pressure can aggravate brain edema and develop to a certain extent, which can cause functional and structural damage to brain tissue. If it can not be diagnosed and treated in time, the cerebral edema will be aggravated, or the development will be diffuse, which will cause serious damage to the brain, form irreversible secondary pathological changes, and cause brain death. This kind of outcome is caused by the general damage of the brain tissue and the severe damage of the brain stem secondary to the brain stem.
Symptom
Symptoms of cerebral edema Common symptoms Brain gray matter abnormal brainwave changes suddenly, painless local edema, increased intracranial pressure, complex partial seizures of epilepsy, unconscious brain softening, blood-brain barrier permeability, high-vision papilledema
Cerebral edema is a secondary pathological process caused by intracranial diseases and systemic diseases. At the same time, cerebral edema often causes or aggravates the increase of intracranial pressure, so the clinical manifestations often overlap with the symptoms of the primary lesions and make them worse.
1. Brain damage symptoms Localized cerebral edema occurs mostly in the local brain lesions such as brain contusion or brain tumors and vascular diseases. Common symptoms are exacerbations of epilepsy and delirium, or due to the widening of water quality, which affects the aphasia of the language movement. After brain injury, if the symptoms gradually deteriorate, more attention should be paid to cerebral edema. Diffuse cerebral edema, which can not be controlled by localized cerebral edema, continues to expand into global cerebral, or diffuse brain edema, such as diffuse axonal injury, at the outset.
2, symptoms of increased intracranial pressure manifested as headache, increased vomiting, restlessness, lethargy and even coma. Fundus examination revealed papilledema. Early signs of changes in vital signs, slowing of pulse and breathing, and compensatory symptoms of elevated blood pressure, such as cerebral edema and high intracranial pressure, can lead to brain edema and cerebral palsy.
3, other symptoms of brain edema affect the frontal lobe, temporal lobe, anterior thalamus can cause mental disorders, severe cases are unconscious, coma. Increased intracranial pressure can also cause mental symptoms. Sometimes the body temperature is moderately elevated, and cerebral edema affects the hypothalamus, which can cause symptoms of damage to the hypothalamus.
Examine
Brain edema examination
The diagnosis of cerebral edema can be prompted from the following aspects:
1. Cerebral edema is secondary to the primary disease. If the clinical symptoms are significantly aggravated in a short period of time, localized cerebral edema should be considered. Patients with cleavage should have severe symptoms of increased intracranial pressure, coma, mostly extensive or whole brain edema. . Application of dehydration treatment, such as diuretic effect, and the condition also improved, also indicates the presence of cerebral edema.
2, intracranial pressure monitoring: intracranial pressure monitoring can display and record the dynamic changes of intracranial pressure, such as increased intracranial pressure, from the intracranial pressure curve combined with clinical process analysis, can suggest the development and regression of cerebral edema.
3, CT or MRI: CT or MRI scan directly prompts the most reliable diagnosis of cerebral edema, CT images show signs, around the lesion or white matter areas, different ranges of low-density areas, MRI on T1 or T2 weighted images The edema area is a high signal, which is more accurate than the CT scan.
Diagnosis
Diagnosis and differentiation of brain edema
diagnosis
1. History: Pay attention to whether there is a large amount of drinking water or excessive water input after burns, whether there is brain trauma, history of poisoning, whether there is severe shock, inhalation injury or other serious or long-term hypoxia or acidosis and alkalosis Wait.
2. Clinical manifestations: increased intracranial pressure and cerebral palsy, respiratory, mental changes and mental symptoms. Children can have high fever and convulsions.
3. Check: whether there is a change in pupil and optic nerve head edema, with or without conjunctival edema or increased intraocular pressure, in the baby with or without a full stomach, increased tension.
4. Test: Pay attention to the presence or absence of hyponatremia, low blood chlorine, plasma protein, acidosis and other poisoning.
5. Lumbar puncture can cause sacral stenosis and infection (especially through burn wounds), generally not suitable.
Differential diagnosis
The disease should be differentiated from intracranial infectious diseases, carbon monoxide poisoning, cerebral hemorrhage, epilepsy.
