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Post-Traumatic Brain Swelling
Anne G. Osborn, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Vasogenic edema (VE), cytotoxic edema (CTE), cerebral edema (CE), diffuse brain swelling (DBS)
            • Definitions

              • Brain, CSF, and blood coexist in closed intracranial compartment
                • To maintain normal ICP, ↑ pressure in 1 compartment must be balanced by ↓ in others (Monro-Kellie doctrine)
              • CE (secondary effect of trauma, ischemia) is dynamic process involving glutamate-mediated excitotoxicity, cell damage
              • 2 basic forms of brain edema in trauma: VE and CTE often coexist
                • VE: Extracellular edema, follows blood-brain barrier (BBB) breakdown
                • CTE: Intracellular (closed barrier) edema

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Angiographic Findings

                        • Nuclear Medicine Findings

                          • Imaging Recommendations

                            DIFFERENTIAL DIAGNOSIS

                              PATHOLOGY

                              • General Features

                                • Gross Pathologic & Surgical Features

                                  • Microscopic Features

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Demographics

                                        • Natural History & Prognosis

                                          • Treatment

                                            DIAGNOSTIC CHECKLIST

                                            • Consider

                                              • Image Interpretation Pearls

                                                Selected References

                                                1. Alves JL: Blood-brain barrier and traumatic brain injury. J Neurosci Res. 92(2):141-7, 2014
                                                2. Lu H et al: The apparent diffusion coefficient does not reflect cytotoxic edema on the uninjured side after traumatic brain injury. Neural Regen Res. 9(9):973-7, 2014
                                                3. Paiva WS et al: Delayed unilateral traumatic brain swelling in a child. J Pediatr Neurosci. 9(2):169-71, 2014
                                                4. Wu H et al: The Diagnosis and Surgical Treatment of Central Brain Herniations Caused by Traumatic Bifrontal Contusions. J Craniofac Surg. ePub, 2014
                                                5. Bor-Seng-Shu E et al: Posttraumatic refractory intracranial hypertension and brain herniation syndrome: cerebral hemodynamic assessment before decompressive craniectomy. Biomed Res Int. 2013:750809, 2013
                                                6. Ren W et al: Occludin and connexin 43 expression contribute to the pathogenesis of traumatic brain edema. Neural Regen Res. 8(29):2703-12, 2013
                                                7. Greve MW et al: Pathophysiology of traumatic brain injury. Mt Sinai J Med. 76(2):97-104, 2009
                                                8. Tollard E et al: Experience of diffusion tensor imaging and 1H spectroscopy for outcome prediction in severe traumatic brain injury: Preliminary results. Crit Care Med. 37(4):1448-55, 2009
                                                9. Galloway NR et al: Diffusion-weighted imaging improves outcome prediction in pediatric traumatic brain injury. J Neurotrauma. 25(10):1153-62, 2008
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Synonyms

                                                            • Vasogenic edema (VE), cytotoxic edema (CTE), cerebral edema (CE), diffuse brain swelling (DBS)
                                                          • Definitions

                                                            • Brain, CSF, and blood coexist in closed intracranial compartment
                                                              • To maintain normal ICP, ↑ pressure in 1 compartment must be balanced by ↓ in others (Monro-Kellie doctrine)
                                                            • CE (secondary effect of trauma, ischemia) is dynamic process involving glutamate-mediated excitotoxicity, cell damage
                                                            • 2 basic forms of brain edema in trauma: VE and CTE often coexist
                                                              • VE: Extracellular edema, follows blood-brain barrier (BBB) breakdown
                                                              • CTE: Intracellular (closed barrier) edema

                                                          IMAGING

                                                          • General Features

                                                            • Radiographic Findings

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Ultrasonographic Findings

                                                                    • Angiographic Findings

                                                                      • Nuclear Medicine Findings

                                                                        • Imaging Recommendations

                                                                          DIFFERENTIAL DIAGNOSIS

                                                                            PATHOLOGY

                                                                            • General Features

                                                                              • Gross Pathologic & Surgical Features

                                                                                • Microscopic Features

                                                                                  CLINICAL ISSUES

                                                                                  • Presentation

                                                                                    • Demographics

                                                                                      • Natural History & Prognosis

                                                                                        • Treatment

                                                                                          DIAGNOSTIC CHECKLIST

                                                                                          • Consider

                                                                                            • Image Interpretation Pearls

                                                                                              Selected References

                                                                                              1. Alves JL: Blood-brain barrier and traumatic brain injury. J Neurosci Res. 92(2):141-7, 2014
                                                                                              2. Lu H et al: The apparent diffusion coefficient does not reflect cytotoxic edema on the uninjured side after traumatic brain injury. Neural Regen Res. 9(9):973-7, 2014
                                                                                              3. Paiva WS et al: Delayed unilateral traumatic brain swelling in a child. J Pediatr Neurosci. 9(2):169-71, 2014
                                                                                              4. Wu H et al: The Diagnosis and Surgical Treatment of Central Brain Herniations Caused by Traumatic Bifrontal Contusions. J Craniofac Surg. ePub, 2014
                                                                                              5. Bor-Seng-Shu E et al: Posttraumatic refractory intracranial hypertension and brain herniation syndrome: cerebral hemodynamic assessment before decompressive craniectomy. Biomed Res Int. 2013:750809, 2013
                                                                                              6. Ren W et al: Occludin and connexin 43 expression contribute to the pathogenesis of traumatic brain edema. Neural Regen Res. 8(29):2703-12, 2013
                                                                                              7. Greve MW et al: Pathophysiology of traumatic brain injury. Mt Sinai J Med. 76(2):97-104, 2009
                                                                                              8. Tollard E et al: Experience of diffusion tensor imaging and 1H spectroscopy for outcome prediction in severe traumatic brain injury: Preliminary results. Crit Care Med. 37(4):1448-55, 2009
                                                                                              9. Galloway NR et al: Diffusion-weighted imaging improves outcome prediction in pediatric traumatic brain injury. J Neurotrauma. 25(10):1153-62, 2008