Traumatic brain edema in diffuse and focal injury: cellular or vasogenic? [chapter]

A. Marmarou, S. Signoretti, G. Aygok, P. Fatouros, G. Portella
Brain Edema XIII  
The objective of this study was to confirm the nature of the edema, cellular or vasogenic, in traumatic brain injury in head-injured patients using magnetic resonance imaging techniques. Di¤usionweighted imaging methods were quantified by calculating the apparent di¤usion coe‰cients (ADC). Brain water and cerebral blood flow (CBF) were also measured using magnetic resonance and stable Xenon CT techniques. After obtaining informed consent, 45 severely injured patients rated 8 or less on Glasgow
more » ... or less on Glasgow Coma Scale (32 di¤use injury, 13 focal injury) and 8 normal volunteers were entered into the study. We observed that in regions of edema, the ADC was reduced, signifying a predominantly cellular edema. The ADC values in di¤use injured patients without swelling were close to normal and averaged 0.89 G 0.08. This was not surprising, as ICP values for these patients were low. In contrast, in patients with significant brain swelling ADC values were reduced and averaged 0.74 G 0.05 ( p < 0.0001), consistent with a predominantly cellular edema. We also found that the CBF in these regions was well above ischemic threshold at time of study. Taking these findings in concert, it is concluded that the predominant form of edema responsible for brain swelling and raised ICP is cellular in nature.
doi:10.1007/3-211-30714-1_6 fatcat:tcyw25loyzblpbrnmyrj6nocpu