Presentation
Head trauma following a fall from stairs.
Patient Data
large left-sided cerebral hemispheric edema with mass effect and left-to-right midline shift
loss of grey-white differentiation suggestive of an associated cytotoxic edema
mild left uncal herniation
left acute subdural hematoma and subarachnoid hemorrhage
left frontal cerebral hemorrhagic contusion
left frontal and parietal bone fracture with subcutaneous hematoma
significant increase in the cerebral edema
increased mass effect, midline shift, and left uncal herniation
onset of a left subfalcine herniation
increase in the size of the subdural and subarachnoid hemorrhage
left frontal, parietal and temporal decompressive craniectomy
persistent massive brain swelling
decreased midline shift and uncal herniation
there is no sign of arterial occlusion or dissection
Case Discussion
Post-traumatic cerebral edema is a combination of three types:
osmotic edema - the contusion necrosis and expansion lead to local tissue osmolarity increase and subsequent edema 1
vasogenic edema - due to the traumatic rupture of the blood-brain barrier (BBB) and to the liberation of neuroinflammation mediators 1
cytotoxic edema - the raised intracranial pressure leads to a reduction of the cerebral perfusion pressure with subsequent ischemia and cytotoxic edema