Combined cerebral edema

Case contributed by Yahya Baba


Head trauma following a fall from stairs.

Patient Data

Age: 4 years

Inital trauma

  • 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

One day later

  • 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

Two days later

  • 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

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