Cerebral edema is fluid accumulation around the brain leading to an increase of internal pressure known as intracranial pressure (ICP). This pressure build-up, if not checked, may cause serious conditions, even resulting in death. Cerebral edema treatment guidelines are primarily based on the underlying cause and severity of ICP.
In minor cases, the brain swelling may get resolved within a few days. However, in a majority of the cases, immediate medical attention is required. The ultimate objective is to reduce ICP and ensure the normal supply of oxygenated blood in the brain for its normal functioning along with treating the underlying causes.
Cerebral edema treatment may involve a combination of medication and surgery. Prompt intervention matters a lot for faster recovery without causing any damage to the brain.
Possible causes of cerebral edema:
Cerebral edema can arise from a number of causes:
- Traumatic brain injury caused by accidental fall or vehicular accident.
- Ischemic stroke caused by a blood clot in the brain.
- Brain tumor.
- Infections caused by bacteria and virus. For example, encephalitis.
- Brain hemorrhage caused by the rupture of blood vessel.
- Travelling in the high altitude of more than 4000 meters.
9 essential Cerebral Edema treatment guidelines:
It is up to the doctors to plan cerebral edema treatment guidelines depending on the prognosis. However, the treatment may involve one or a combination of several procedures described below.
Drugs to reduce swelling and prevent blood clots constitute the first step of treatment. Warfarin is the common treatment medication used for this purpose. It thins the blood, reducing the chances of clotting.
Sometimes doctors may recommend aspirin, but it is no longer recommended in the current cerebral edema treatment guidelines owing to a higher risk of bleeding.
Surgery may be advised in severe cases of cerebral edema. This may have one of the two objectives.
- A part of the skull may be removed to reduce intracranial pressure.
- Rectifying the source of swelling. It may be the removal of a growth or repairing a damaged artery or vein after stroke.
In this procedure, a plastic tube is inserted into the skull to drain out the excess fluid.
This is one of the most rapid ways to reduce tissue water and brain bulk. An osmotic gradient is created to reduce the blood viscosity that decreases ICP and increases CBF (cerebral blood flow). Mannitol is commonly used for its efficacy. Glycerol is another useful osmotic agent which is orally administered.
These are effective in lowering ICP, mainly in vasogenic edema, but are not recommended for treating brain swelling after stroke or hemorrhage. They are used in treating chronic meningitis or acute bacterial meningitis when antibiotics are on. Glucocorticoids are used for management of malignant brain tumors. They are known to affect brain tumors by reducing vasogenic edema.
Lowering body temperature (Hypothermia):
Lowering the temperature of the body helps in relieving intracranial pressure, thereby allowing the brain to heal. It is not universally accepted in the cerebral edema treatment guidelines since the procedure is not easy to perform.
Controlled hyperventilation is effective in lowering raised ICP. Within minutes of the onset of hyperventilation, ICP falls dramatically. However, it is important to monitor hyperventilation by blood gas analysis and chest radiograph. The pCO2 should not fall below 25 mm Hg.
Giving IV fluids:
Intravenous fluids can prevent a sudden fall in blood pressure and ensure that the body – including the brain – receives enough blood flow. Although this is a part of the cerebral edema treatment guidelines, some IV fluids can worsen brain swelling.
Treatments to reduce brain swelling naturally:
This involves four procedures as follows:
Hyperbaric Oxygen Therapy (HBOT):
Cerebral edema causes inflammation that blocks the normal oxygen flow to the brain. In HBOT, the patient is placed in a highly pressurized total body chamber where he is allowed to breathe 100% oxygen. The inhaled oxygen from HBOT dramatically increases the oxygen content in the blood plasma.
As the capillary walls get enriched with oxygen, leakage from plasma is stopped, aiding in the reduction of brain swelling. The blood flow gets restored, creating conditions for regeneration of nerve cells. HBOT has been a proven treatment to reduce brain swelling in clinical trials with animals. In a number of cases with humans, the therapy has shown significant improvement in cognitive function and mood.
Anti-inflammatory foods in Ketogenic diet:
This may be a promising therapy to reduce brain swelling naturally and may find a place in cerebral edema treatment guidelines. In cerebral edema, the glucose intake to provide the necessary energy for healing gets blocked. It is the ketone bodies that can act as a viable energy source. Fatty acid oxidation in the liver can produce enough ketone bodies to be delivered to the brain.
High-fat low-carb Ketogenic diet with adequate protein can hasten this healing. This has been effective in reducing brain inflammation in rats. Foods helping in reducing brain inflammation are as follows:
- Fatty fish like Salmon
- MCT oil present in high levels in coconut
- Olive oil
Trans Cranial Low-Level Laser Therapy (LLLT):
This therapy works by reducing the inflammation causing agents like prostaglandins. This is a safe procedure and is found effective in reducing brain swelling in rats caused by traumatic injury. In humans, this therapy has shown marked improvement in cognitive functions.
From a peripheral LLLT device, red or near-infrared light is allowed to penetrate the skull. It induces a photochemical reaction causing an increase in mitochondrial ATP production.
Stem Cell Therapy:
The aim of this therapy is to boost the reparative property of the brain cells post injury or an ailment. In case of damaged brain tissue, immune cells work hard to activate the stem cells of the site by releasing pro-inflammatory cytokines.
But when the inflammation is beyond control, the stem cells can become inactive and die. In such a condition, pluripotent cells are infused to reinforce cytokines and other growth factors. This has been found effective in reducing brain swelling in recent clinical trials. Stem cell therapy can also be carried out in tandem with Platelet Rich Plasma (PRP) therapy.
Progress is being made on novel treatments where brain swelling can be prevented by checking fluid accumulation. It needs a strategy with a deep understanding of molecular mechanisms causing the formation of edema.