Cerebral edema

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:

• cytotoxic cerebral edema

  • ionic cerebral edema 

• vasogenic cerebral edema

• osmotic cerebral edema

Special types of edema to be considered: 

• transependymal edema (also known as interstitial cerebral edema)

• combined cerebral edema

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 (dual antagonist of AVP V₁A and V₂ receptors)

• fingolimod (sphingosine-1-phosphate receptor modulator)

• celecoxib (COX-2 inhibitor)

• glyburide (antidiabetic sulfonylurea)

• human corticotropin-releasing factor (hCRF)

• bevacizumab (humanized monoclonal VEGF-A inhibiting antibody)

• cediranib (potent pan-VEGF RTK inhibitor)