Treatment of Cerebral Edema

BACKGROUND: Cerebral edema is a potentially devastating complication of various acute neurologic disorders. Its successful treatment may save lives and preserve neurologic function. REVIEW SUMMARY: Different pathophysiological mechanisms are responsible for the formation of cytotoxic and vasogenic edema. Yet, these 2 types of edema often coexist and their treatment tends to overlap, with the exception of corticosteroids, which should be only used to ameliorate vasogenic edema. Currently available to control brain swelling include osmotic agents (with emphasis on mannitol and hypertonic saline solutions), corticosteroids, hyperventilation, sedation (propofol, barbiturates), neuromuscular paralysis, hypothermia, and surgical interventions. This article discusses the indications, advantages, and limitations of each treatment modality following an evidence-based approach. CONCLUSIONS: The therapy for brain edema remains largely empirical. More research aimed at enhancing our understanding of the pathophysiology of cerebral edema is needed to identify new and more effective forms of treatment.