Cerebral edema

Last revised by Jeremy Jones on 3 Apr 2023

Cerebral edema refers to a number of interconnected processes which result in abnormal shifts of water across various compartments of the brain parenchyma. It is observed in the majority of injuries involving the central nervous system 5.

It has traditionally been broadly divided into vasogenic cerebral edema and cytotoxic cerebral edema, the latter a term commonly used to denote both true cytotoxic edema and ionic edema 4. In addition, although traditionally not included in discussions on edema, hemorrhagic transformation can be thought of as an extreme end-stage form of the same processes which lead to edema. 

As such, a more precise classification is 3,4:

Special types of edema to be considered: 

Treatment and prognosis

Promising drugs for the pharmacological treatment of cerebral edema in any clinical trial phase, include (but are not limited to) 5:

  • conivaptan, a dual antagonist of arginine vasopressin (AVP) V1A and V2 receptors

  • fingolimod, a sphingosine-1-phosphate receptor modulator

  • celecoxib, a COX-2 inhibitor

  • glyburide, an antidiabetic sulfonylurea

  • human corticotropin-releasing factor (hCRF)

  • bevacizumab, a humanized monoclonal VEGF-A inhibiting antibody

  • cediranib, a potent pan-VEGF RTK inhibitor

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Cases and figures

  • Case 1: vasogenic edema
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  • Case 2: combined edema
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  • Case 3: osmotic edema
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  • Case 4: cytotoxic edema
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