Cerebral oedema: pathophysiology

Pathophysiology of cerebral oedema

Two mechanisms are generally used to describe the pathophysiology of cerebral oedema.

The first is due to the breakdown of the tight endothelial junctions which make up the blood brain barrier (BBB). This allows intravascular proteins and fluid that are normally excluded to penetrate into the cerebral parenchymal extracellular space.

Once plasma constituents cross the BBB, the oedema spreads (in a manner that can be quite fast and widespread).

The second mechanism results from the swelling of glia, neurons, and/or endothelial cells. Edema begins within minutes of an insult and is most likely due to the release of toxic factors from neutrophils and/or bacteria.


Which of the following would be most useful in a patient with cerebral oedema?