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Cerebral edema

Background

Overview

Definition
Cerebral edema is a disorder characterized by an increase in brain tissue water, including in individual cells and their surrounding tissues, with resultant intracranial hypertension.
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Pathophysiology
Cerebral edema can be broadly classified as cytotoxic edema (due to ischemic stroke), vasogenic edema (due to neoplasm, hemorrhage, venous thrombosis, or arterio-venous shuts), or interstitial edema (due to hydrocephalus).
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Disease course
Cerebral edema presents with manifestations of intracranial hypertension, irreversible brain injury, cerebral herniation, and death.
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Prognosis and risk of recurrence
Cerebral edema associated with mass lesions is associated with an estimated in-hospital mortality of > 60%. In the context of ischemic stroke, the development of cerebral edema is associated with mortality of > 50%.
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Guidelines

Key sources

The following summarized guidelines for the management of cerebral edema are prepared by our editorial team based on guidelines from the U.S. Department of Health and Human Services (DHHS 2025), the American Heart Association (AHA/ASA 2022,2018), the Neurocritical Care Society (NCS 2020), the Brain Trauma Foundation (BTF 2017), the World Health Organization (WHO 2017), the European Stroke Organisation (ESO 2014), ...
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Inpatient care

General principles
As per NCS 2020 guidelines:
Monitor both sodium and chloride serum concentrations to assess risk of AKI related to hypernatremia and hyperchloremia.
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Avoid hyponatremia in patients with severe neurological injury, due to the risk of exacerbating cerebral edema.
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  • Elevation of the head of the bed

  • Brief hyperventilation

  • Monitoring of renal function

  • Monitoring of serum sodium and chloride

  • Monitoring of serum osmolar gap

Therapeutic procedures

CSF diversion: as per NCS 2020 guidelines, consider performing CSF diversion as a beneficial adjunct to reduce ICP.
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Specific circumstances

Patients with traumatic brain injury: as per NCS 2020 guidelines, consider using hypertonic sodium solutions over mannitol for the initial management of elevated ICP or cerebral edema in patients with traumatic brain injury.
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  • Patients with cryptococcal meningitis