Brain edema

The term Brain edema refers to swelling (edema) of the brain that occurs when the brain increases in volume and pressure. There are many causes of brain edema. If it is not recognized and treated quickly enough, it can be life-threatening and lead to brain death.

What is brain edema?

The typical signs and symptoms usually set in suddenly and quickly increase in intensity. The main characteristics are severe headache and neck pain, nausea and vomiting, and dizziness.
© vecton - stock.adobe.com

The brain can swell as a result of injury, illness, or any other reason. Brain edema is the increase in brain volume and thus increased intracranial pressure, caused by the accumulation of fluid in the tissue crevices or brain cells.

This accumulation of fluid is severe in that the brain embedded in the bony skull can hardly expand. Brain swelling is usually difficult to treat and can quickly lead to serious problems, including death. Depending on the cause, swelling can occur in specific areas in the brain or throughout the brain.

Wherever it occurs, the pressure in the skull increases. With swelling, there is a risk that the brain will not get enough blood supply and thus too little oxygen to function, which can lead to brain death. In addition, the swelling may block other fluids and prevent them from draining from the brain, making the swelling worse.

causes

The causes of a Brain edema are diverse. In a traumatic brain injury (TBI), a sudden event such as a fall, traffic accident or blow to the head damages the brain. The brain tissue itself can swell from the injury and also from bone fragments that injure the blood vessels in the brain.

Ischemic stroke is caused by a blood clot or blockage in or near the brain. As soon as this is no longer supplied with vital blood and oxygen, brain cells begin to die and the brain swells. In the case of cerebral hemorrhage, in which a blood vessel in the brain bursts due to excessive blood pressure, for example, swelling occurs due to the leakage of blood.

Infections such as meningitis, encephalitis, and toxoplasmosis can also cause brain swelling. Brain tumors can put pressure on areas of the brain, block the drainage of fluids and thus cause swelling. After all, brain swelling can occur at altitudes above 1500 meters (altitude sickness).

Symptoms, ailments & signs

A range of symptoms can occur depending on the cause and extent of the brain edema. The typical signs and symptoms usually set in suddenly and quickly increase in intensity. The main characteristics are severe headache and neck pain, nausea and vomiting, and dizziness. In some people, the breath stops or becomes irregular.

This can lead to visual disturbances or even complete loss of vision. In connection with this, eye muscle paralysis can occur. Memory loss and gaps in memory are also signs of brain edema. At the beginning, the brain tumor symptoms are in many cases similar to the symptoms of Alzheimer's disease in the first stage.

In the course of the disease, difficulties in speaking arise relatively quickly. The characteristic restlessness of movement increases and seizures or stupor set in. As a result of the rise in intracranial pressure, there is a risk that areas of the brain will become pinched, which can cause brain damage.

In the absence of treatment, cerebral edema can cause permanent damage and, for example, permanently limit the ability to see or speak or impair motor skills. In the worst case, cerebral edema leads to cardiac arrest with brain death. To avoid this, a doctor should be consulted at the first signs of brain edema.

Diagnosis & course

The symptoms of a Brain edema vary depending on the cause and extent. They usually set in suddenly. Possible signs of cerebral edema include sudden headache, neck pain or stiffness, nausea and vomiting, dizziness, irregular breathing, loss or disturbance of vision, memory loss, difficulty speaking, restlessness, stupor (freezing), seizures, impaired consciousness, paralysis of the eye muscles, and fainting .

As a result of the increase in intracranial pressure, there is a risk that areas of the brain will be pinched, which can lead to damage. Hence, prompt treatment is of the utmost importance.

Cerebral edema can be diagnosed through various tests. These include a neurological exam, a CT scan, an MRI of the head to see the extent and location of the swelling, and blood tests. The intracranial pressure itself can be measured using a catheter or a probe.

Complications

The brain edema itself is a complication and can develop as a result of surgery, injuries or illness. Because of the increasing pressure in the brain, brain matter can be displaced. As a result, vital structures are impaired, so that in the worst case, brain edema leads to cardiac arrest with brain death.

Even if this can be prevented, permanent damage will result from the course of the process, since brain cells die due to the lack of oxygen. The decisive factor is the location of the brain edema and which regions are affected. In this way, perception as well as language skills or motor skills can be disturbed. Breathing problems are also possible.

In any case, it is necessary that the brain edema be treated as soon as possible. This is the only way to avoid brain damage and save the person affected from brain death. Since drugs are administered to promote excretion, side effects can occur in the case of hypersensitivity.

While medication and a special type of storage can often be sufficient to reduce the swelling and reduce the burden on the brain, surgical interventions are necessary in certain cases. This involves removing part of the skull bone and exposing the brain. Such interventions naturally also harbor complications, but often decide on the survival of the person affected.

When should you go to the doctor?

If symptoms such as headache, dizziness, and high blood pressure occur at the same time, it may be caused by brain edema. A doctor should be consulted if the symptoms persist for more than a week. If the symptoms increase in intensity and noticeably impair well-being, medical advice must be obtained immediately. If there are complications such as impaired consciousness or repeated vomiting, it is best to go to a hospital. Brain edema occurs primarily in connection with traumatic brain injuries or brain tumors.

Edema also occurs again and again after infections such as encephalitis or meningitis. Anyone who belongs to these risk groups should consult their doctor as soon as possible if the symptoms are mentioned. Children, the elderly and pregnant women should also go to a doctor if they have unspecific complaints that indicate a serious illness. Emergency medical treatment is required in the event of loss of consciousness or seizures. The first aiders must also provide first aid measures and bring the person affected into a stable lateral position. A longer hospital stay is then usually indicated, during which the symptoms are clarified and any cerebral edema is surgically removed.

Doctors & therapists in your area

Treatment & Therapy

Lighter ones Brain edema, conditional e.g. due to moderate altitude sickness or a slight concussion, often resolve within a few days. In most cases, however, cerebral edema requires immediate treatment and intensive medical monitoring.

It is important to ensure that the brain is supplied with sufficient blood and oxygen, that the swelling is reduced and that the causes that trigger the cerebral edema are treated. Treatment can include a variety of medical and surgical treatments.

Patients are positioned with the torso raised and the head straight. Oxygen is supplied through a breathing mask and blood pressure is kept low with medication or intravenously. Sedation may be useful to reduce blood flow and thus pressure in the brain. Hypothermia treatment, i.e. lowering the body temperature, protects affected areas of the brain by reducing the brain's energy requirements. With diuretics such as high-dose corticosteroids, the excretion of fluids through the kidneys is promoted and thus the brain edema is reduced.

Possible surgical interventions include the ventriculostomy, in which liquid (liquor) is drained through a small opening in the skull and the cerebral edema is relieved. A decompressive craniectomy is also effective, in which the bony roof of the skull is surgically removed over the swelling area in order to give the cerebral edema more space until it has subsided. In the case of a tumor, it is surgically removed as far as possible.

You can find your medication here

➔ Medicines for headaches and migraines

Outlook & forecast

The prognosis for a patient with cerebral edema essentially depends on two factors: The trigger for the cerebral edema is decisive on the one hand, and the severity of the symptoms on the other. When it comes to the trigger, it depends on whether it is a permanently reversible cause. For example, if it is a brain tumor that is very malignant, the prospect of a cure is poor. Because even if the cerebral edema should temporarily recede due to certain drugs, the swelling occurs again in many cases due to the growth of the tumor and destroys other areas of the brain.

The severity of the edema is also an important criterion for the prognosis of the patient. The more an edema has spread in important areas of the brain, the more areas of the brain are destroyed and their functions are restricted or completely eliminated. This happens because the intracranial pressure increases increasingly due to the edema, as it spreads through the natural limitation of the solid skull capsule. Therefore, the prognosis is often poor if there is severe edema formation.

This is especially the case when the time between the appearance of the damaging edema and the initiation of necessary treatment measures is very long. If there is an additional source of bleeding in addition to cerebral edema, for example in the event of an accident or cerebral hemorrhage, this worsens the prognosis.

prevention

Prevention is with you Brain edema problematic, due to the causes that usually set in suddenly and unpredictably. Elevation of the upper body, antihypertensive and antihypertensive therapy, and administration of diuretic drugs can reduce swelling, but often cannot prevent it. If the conservative treatment is ineffective, surgical opening of the skull may be necessary.

Aftercare

The aftercare measures that must be taken after brain edema depend on the cause and consequences of the swelling and the type of treatment. If an injury is the cause, it will be checked as part of the follow-up checks. If there are no complications or the injury has been completely healed, the cause does not need to be included in the follow-up care.

If the brain edema is caused by poisoning, additional blood tests may need to be done to ensure that the toxin has been completely eliminated. Aftercare for brain edema is carried out by a neurologist. The doctor will do a CT scan and will also do a physical exam. In the case of permanent brain damage, among other things, relearning lost skills is part of the aftercare.

The therapeutic measures required in each case depend on the type and severity of the brain damage. Basically, the patient must visit the doctor regularly so that the health progress can be checked. In addition, the medication must be regularly adapted to the symptoms. Typically used drugs with the active ingredients clopidogrel or edoxaban reduce any pain, prevent blood clots and lower the risk of a heart attack after brain swelling. The neurologist responsible has to decide which measures make sense in detail.

You can do that yourself

Brain edema cannot be treated as part of self-help measures. As a rule, those affected are always dependent on medical treatment and in many cases also on surgical intervention.

In some cases, the symptoms can be relieved with the help of diuretics. However, this is only a temporary treatment. If the person concerned has had an accident in which the head was also damaged, the brain should always be examined. Regular medical examinations are necessary even after successful treatment. If the person concerned loses consciousness due to the brain edema, an emergency doctor must be called immediately or the nearest hospital visited. An early detection and treatment of the disease has a very positive effect on the further course. In most cases the symptoms disappear completely after the treatment, so that further measures are no longer necessary.

If the symptoms of cerebral edema occur at a great height, this height must be left immediately. This can prevent further discomfort or bleeding. In the event of a stroke, the patient is often dependent on the help of other people in his everyday life. The help of friends and family is particularly helpful.