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Arch Hellen Med, 36(1), January-February 2019, 64-72


The clinical approach to cerebral edema: From pathophysiology to goal-directed treatment

I. Dalakakis, G. Tsaousi
Department of Anesthesiology and Intensive Care Unit, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

Cerebral edema is a major complication of a wide range of pathological conditions of the central nervous system and other systemic disorders, associated with an increase in morbidity and mortality. Primary brain damage affects the permeability of the blood brain barrier, while acute energy crisis of the brain cells results in ion channel dysfunction. The most important clinical manifestation of these two pathophysiological states is induction of angiogenic or cytotoxic brain edema, respectively. In many cases, however, these two major pathophysiological disorders coexist, and as a result the therapeutic approach becomes more complex and challenging. The treatment of brain edema is based primarily on general supportive measures, with interventions such as the administration of hyperosmolar agents and corticosteroids. In recent years, various pathophysiological mechanisms and mediators of neuroinflammation have been identified. Of these, the aquaporins, which are transmembrane water transport proteins, are of major interest. These breakthrough research developments have led to innovative experimental forms of treatment that will be implemented at the clinical level in the coming years.

Key words: Angiogenic edema, Aquaporins, Cerebral edema, Cytotoxic edema, Hyperosmolar therapy.

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