Acute Treatment of Cerebral Edema in Neurocritical Care Patients

Patient Guideline Summary

Publication Date: May 15, 2015
Last Updated: March 3, 2023

Objective

Objective

This patient summary means to discuss key recommendations from the Society of Critical Care Medicine, the American Academy of Neurology, and the American Association of Neuroscience Nursing for acute treatment of cerebral edema in neurocritical care patients.

Overview

Overview

  • Cerebral edema is brain swelling. Brain swelling impairs brain function because the skull does not expand to reduce pressure, and increasing pressure reduces blood flow to the brain.
  • Cerebral edema can result from almost any abnormal condition of the brain. The most common causes are trauma, infection, and stroke.
  • Symptoms include headaches, nausea, vomiting, altered consciousness, weakness, visual disturbances, seizures, sensory changes, and double vision.
  • This patient summary focuses on treating cerebral edema in the intensive care setting.

Diagnosis

Diagnosis

  • Specific causes of cerebral edema are discussed in this guideline:
    • Subarachnoid Hemorrhage: Bleeding around the brain
    • Intracerebral Hemorrhage: Bleeding inside the brain
    • Traumatic Brain Injury: Direct injury to the brain
    • Acute Ischemic Stroke: Interruption of blood flow to a part of the brain
    • Bacterial Meningitis: Infection in the brain
    • Hepatic Encephalopathy: Brain damage due to liver failure
  • Identifying and monitoring elevated pressure is achieved by imaging studies or devices attached to or inserted inside the skull.

Treatment

Treatment

  • Medical
    • Hypertonic infusions
      • Salt solutions
      • Mannitol. Notes:
        -Hypertonic solutions draw fluid into the circulation and therefore out of the brain.
        -Hypertonic infusions must be managed carefully because they can damage the kidneys.
    • Corticosteroids (cortisone) reduce inflammation caused by infections.
  • Non‑pharmacological treatment of cerebral edema
    • Elevating the head of the bed to 30 degrees
    • Hyperventilation causes beneficial changes in blood circulation in the brain.
    • CSF diversion
      • It is possible to insert a tube into the skull that will drain fluid away and reduce pressure.
    • Surgery
      • Open surgical procedures can remove blood from inside the skull or provide more space for the brain to swell.

Source Citation

Cook AM, Morgan Jones G, Hawryluk GWJ, Mailloux P, McLaughlin D, Papangelou A, Samuel S, Tokumaru S, Venkatasubramanian C, Zacko C, Zimmermann LL, Hirsch K, Shutter L. Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients. Neurocrit Care. 2020 Jun;32(3):647-666. doi: 10.1007/s12028-020-00959-7. PMID: 32227294; PMCID: PMC7272487.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.