ABSTRACT
Cerebral edema and intracranial hypertension can develop in the setting of various brain pathologies including brain tumors, encephalitis, meningitis, metabolic encephalopathies, subarachnoid hemorrhage, intraparenchymal hemorrhage, malignant ischemic stroke and most often in traumatic brain injury. The best studied and understood of the conditions is traumatic cerebral edema, often diffuse, causing intracranial hypertension which is dangerous because it compromises cerebral perfusion. The idea that swelling occurs in the head and that release of intracranial pressure may be therapeutic has been around for years dating back to ancient Egyptian times with evidence across continents of trephination being performed. Mannitol and hypertonic saline work by shrinking the brain to create more space intracranially and prevent herniation. The former is an osmotic diuretic which causes cellular dehydration and if improperly managed can cause renal and multi-organ failure. Hypothermia is effective in lowering Intracranial pressure (ICP) but causes shivering and increased metabolism and can result in increased ICP.
