Cerebral oedema

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  • Two principle types;
  • Vasogenic oedema
    • Occurs when the integrity of the BBB is compromised and increased vascular permeability occurs
    • Allows fluid to escape from the intravascular compartment into the intracellular space
    • Reabsorption of ECF is inhibited by the lack of lymphatics and the close apposition of the cell processes of neurones and glial cells
    • May be either localised, when it results from abnormally permeable vessels adjacent to inflammatory lesions or neoplasms or can be generalised
  • Cytotoxic oedema
    • Implies am increase in intracellular fluid secondary to neuronal, glial or endothelial cell membrane injury
    • May be encountered associated with generalised hypoxia/ischaemia or with certain intoxifications

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  • Generalised oedema often has elements of vasogenic and cytotoxix oedema
  • Interstitial oedema occurs especially around the lateral ventricles when there is an abnormal flow of fluid from the intraventricular CSF across the ependymal lining to the perivertricular white matter. This occurs in the setting of increased intraventricular pressure

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Morphology

  • Gyri are flattened
  • Sulci are narrowed
  • Ventricular cavities are compressed
  • Herniation may occur

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