This is an abnormality that can occur due to multiple potential causes. It is treated based on the underlying cause and severity.
Diagnosis:
CT:
- Hypodensity
- Local effacement of sulci and ventricles and cisterns
- Blurring of the grey-white interface
MRI:
- DWI: Allows differentiation between vasogenic (no abnormal diffusion restriction) vs. cytotoxic (abnormal diffusion restriction) types of cerebral edema
- FLAIR: hyperintensity, Local effacement of sulci and ventricles and cisterns
- T2: hyperintensity, Local effacement of sulci and ventricles and cisterns
- T1: not very sensitive, may show hypointensity
- T1 plus contrast: may show enhancement if the Blood brain barrier (BBB) is interrupted
Treatment:
Treat the underlying cause
Consider steroids (dexamethasone for some causes:
- Steroids useful in brain tumor cerebral edema
- No steroids for stroke (ischemic or hemorrhagic) cerebral edema
- No steroids for traumatic brain injury (TBI) cerebral edema
Consider treatment of raised intracranial pressure (ICP) if necessary:
- see under ICP section
Consider Surgical decompression even if ICP is normal in certain circumstances:
- Large Middle cerebral artery infarcts
- Large cerebellar hemisphere infarcts or hemorrhages
Avoid hypotonic fluids