The Management of Cerebral Edema in Pediatric Practice

Abstract

Cerebral edema is one of the most dreaded complications associated with many central nervous system (CNS) disorders. The condition adds significantly to the morbidity from such diverse conditions as neonatal hypoxia and hypernatremia, water intoxication, meningitis, encephalitis, birth trauma, lead poisoning, and radiation therapy of the brain, as well as brain tumors and abscesses. Cerebral edema increases the volume of the intracranial contents and, thus, may precipitate the intracranial translocation syndromes of uncal and tonsillar herniation which often result in death. Indeed, the mass effect due to edema of the CNS tissue (brain, cord) is often more harmful than is that of the underlying blood clot, tumor, or other pathologic process (Fig. 1). Diffuse and widespread cerebral edema can produce massive increases in intracranial pressure. The successful treatment of cerebral edema, therefore, remains a matter of paramount importance and may have a critical effect upon the patient's prognosis. Two types of therapeutic measures must be considered: (1) those that diminish the volume of intracranial contents in a nonspecific manner, and (2) those that reduce cerebral edema per se. An understanding of their correct use is essential.1,2 Prevention of cerebral edema is, of course, preferable to treating it. In infants and children undergoing neurosurgical operations, preoperative prophylactic measures can be instituted to reduce the magnitude of postoperative cerebral edema. In most situations, however, therapy cannot be initiated before the edema-producing insult occurs. Nevertheless, steps to minimize the development of cerebral edema often may be taken, and these will be discussed. Cerebral edema has been defined as the abnormal accumulation of fluid in cerebral tissue.