Edema and swelling of the brain

Edema and swelling of the brain - the increase in brain volume in the kind of violations of water-salt metabolism.
Etiology, a pathogeny, a pathological anatomy. Developing in various diseases, brain swelling, variabelno by their morphological and biochemical parameters, as well as in their clinical and thanatological value. Often swelling of the brain is combined with its swelling. The difference in the pathogenesis of swelling and edema of the brain, according to a widespread opinion is that when swelling of the brain is the binding of the water colloids of the brain due to increase their hydrophilicity, while the swelling of the brain is a violation of the permeability of vascular walls and the accumulation of liquid in tissue cracks. Nevertheless pathogenetic the proximity of these phenomena is so pronounced that a clear distinction between them is not always possible.
"Swell"or "turgescence", brain described N. I. Pirogov in 1865, This problem has acquired special interest at present in connection with the development of neurosurgery. Most often swelling of the brain in combination with edema occurs in focal processes in the brain (tumor, abscess, infection granuloma and so on), as well as brain damage; in children edema and swelling of the brain are marked with different infectious toxicosis of origin, and the newborn at birth trauma.
Inflammation and swelling of the brain are particularly pronounced in the white matter near the lesion and gradually decrease as the distance from the latter.
Macroscopically this is reflected in a significant increase in the size of the white matter in the circle of fire, which leads to the increase of the volume of the relevant hemisphere (Fig. 1), while the bark of a brain seems even narrowed. The consistency of the swollen parts of the brain plotnosti, the cut surface is dry. If swelling of the brain is accompanied by edema, the cut surface is more humid, and when edema is prevalent, the brain becomes flabby and from the cut surface flows rich edema fluid. Histologically characteristic swelling of the myelin sheaths, or even with the formation of a flask-shaped bumps along the nerve fibers (Fig. 2), and unusual changes neuroglia. In the pathogenesis of swelling and edema of the brain play an important role, apparently, vasomotor-trophic disorders (N. N. Burdenko, A. I. Arutyunov, N. N. Klosowski and others).
Inflammation and swelling of the brain (along with focal processes that increase the volume of intracranial content) lead to increased intracranial pressure and can cause death, especially if the process has spread to the brain stem and caused disruption of vital centers.
Inflammation and swelling of the brain - the process is reversible. After removal of pathologic focus it can regress; however, if this process dragged on for a long time, comes the destruction and melting of a significant part of myelinated fibers. Thus, one can distinguish two stages of violations of water-salt metabolism in the brain: the first - with the reversible change and the second - destructive (B. S. Huminski).
A special form of swelling of the brain, which occasionally observed in General infection, intoxication and mental illness, characterized not by the increase of water content, but on the contrary, the increase of dry residue, which is caused by the violation is not water, and protein metabolism.

Fig. 1. Swelling and edema cerebral hemispheres of the brain in tumors (glioblastomas).
Fig. 2. Swelling of the brain: balanovskii flatulence (1) myelinated fibers (stained with hematoxilin Kulchytsky; x 360).

The clinical picture. Clinically differentiate swelling from swelling of the brain difficult. These disorders can develop after craniocerebral injuries, brain tumours, abscesses, encephalitis, during or after the brain surgery, vascular and other diseases of the brain, as well as in various diseases not related to the primary lesion of the brain. Inflammation and swelling of the brain most often occur in the white matter of the brain or its different parts. The distribution of these violations to stem the brain are often the cause of death of patients. Regardless of the nature of the process of swelling and edema of the brain can develop from the first day after the disease, brain injury or surgery on it, reaching a maximum of 5-6 day, gradually regressive to 10-15 th day. Sudden swelling and swelling of the brain most often develops in patients with malignant tumors and abscesses of the brain.
Depending on the localization process in the brain, the nature of the disease and severity of craniocerebral trauma clinical picture of swelling and edema may be different. In some cases, on the background of the main disease develops weakness, drowsiness, increasing headache, joins vomiting and found congestive nipples in the fundus. Uncover or amplified focal symptoms (paresis, paralysis, and others). Next comes the regression of symptoms, with the exception of symptoms associated with brain tumor or trauma of the substance of the brain. In other cases, with the rise of the oedema and swelling of the brain and involving in this process of brain stem structures can develop seizures, increasing lethargy, drowsiness, down to a coma, found oculomotor violations, fade reflexes appear pathological reflexes, developing cardiovascular disorders, respiratory failure and thermoregulation, patients often leading to death.
Treatment. Fighting increased intracranial pressure is conducted by an intravenous injection of hypertonic solutions to evacuate edema fluid from the brain tissue (5-10 ml 10-15% solution of sodium chloride and 40-50 ml of 40% glucose solution). Favorable effect an intramuscular injection of 10 ml of 25% solution of magnesium sulfate. In the absence of kidney damage can be assigned intramuscular injection of 1 ml of noworyta in 2-3 days or 0.5-1 ml of Mercosul through the day. Assign inside gipotiazid tablets to 0,025 g 1-2 times a day. It is also shown lumbar puncture in the supine position: slowly remove small amounts of liquid with special care for suspected brain tumor or occlusive hydrocephaly. In these cases it is better to resort to fasting puncture lateral ventricle or the establishment of long-term drainage in it.
Edema and swelling of the brain reach the greatest development for 3-5 days after injury or surgery on the brain, and this gap in time should be used for treatment and preventive measures. It is also recommended that intramuscular ganglioblokatorov within 2-3 days (5% pentamin or 2% geksony 1 ml 2-3 times a day) under control of blood pressure levels.
In severe cases, if the patient has no lesions of the kidneys and liver, and the content of residual nitrogen in the blood does not exceed the normal level, the most effective means of combating edema and swelling of the brain is intravenous drip (speed of 40 to 60 drops per 1 min) 30% urea solution 10% sucrose solution at the rate of 1 g/kg In the absence of effect within 3 hours after the infusion should discuss the indications for decompressive or discharging operations or audits wounds after surgery. As after the introduction of urea during or after surgery sometimes is increased bleeding tissue, oseltamivir need to re-enter a small dose vikasola, calcium chloride. During the first days after the application of urea is necessary to observe water balance sick and adjusted intravenous drip infusion 500-800 ml izotoniceski solution of glucose, ringer's solution with the addition of 200 mg ascorbic acid 100 mg of vitamin B1.
The clinic has found application and powerful new dehydrating agent - mannitol (20-25% solution at the rate of 1 g/kg with the introduction of a total solution for 10-15 minutes). The drug that exceeds the action of urea, low toxicity and can be used in patients with kidney disease.