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Posttraumatic Brain Swelling
Surjith Vattoth, MD, FRCR; Anne G. Osborn, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • 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 intracranial pressure (ICP), ↑ pressure in one compartment must be balanced by ↓ in others (Monro-Kellie doctrine)
                • Dynamic, multifactorial, including genetic, excitotoxicity, contact-kinin system, and plasminogen activator inhibitor-2
                • 2 basic forms of brain edema in trauma: VE and CTE
                  • VE: Extracellular edema, follows blood-brain barrier (BBB) breakdown; initially
                  • CTE: Intracellular (closed barrier) edema; later
                • Juvenile head trauma syndrome: Diffuse brain or hemispheric swelling after single trivial injury
                  • Due to rapidly progressive reactive hyperemia

              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. Griemert EV et al: Deficiency of plasminogen activator inhibitor type 2 limits brain edema formation after traumatic brain injury. J Neurotrauma.36(14):2272-8, 2019
                                                  2. Hopp S et al: Alleviation of secondary brain injury, posttraumatic inflammation, and brain edema formation by inhibition of factor XIIa. J Neuroinflammation. 14(1):39, 2017
                                                  3. Mckee AC et al: The neuropathology of traumatic brain injury. Handb Clin Neurol. 127:45-66, 2015
                                                  4. Alves JL: Blood-brain barrier and traumatic brain injury. J Neurosci Res. 92(2):141-7, 2014
                                                  5. 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
                                                  6. Paiva WS et al: Delayed unilateral traumatic brain swelling in a child. J Pediatr Neurosci. 9(2):169-71, 2014
                                                  7. Wu H et al: The diagnosis and surgical treatment of central brain herniations caused by traumatic bifrontal contusions. J Craniofac Surg. 25(6):2105-8, 2014
                                                  8. 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
                                                  9. 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
                                                  10. Squier W et al: The pathophysiology of brain swelling associated with subdural hemorrhage: the role of the trigeminovascular system. Childs Nerv Syst. 28(12):2005-15, 2012
                                                  11. Greve MW et al: Pathophysiology of traumatic brain injury. Mt Sinai J Med. 76(2):97-104, 2009
                                                  12. 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
                                                  13. 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

                                                        • Pathology

                                                          • 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 intracranial pressure (ICP), ↑ pressure in one compartment must be balanced by ↓ in others (Monro-Kellie doctrine)
                                                                • Dynamic, multifactorial, including genetic, excitotoxicity, contact-kinin system, and plasminogen activator inhibitor-2
                                                                • 2 basic forms of brain edema in trauma: VE and CTE
                                                                  • VE: Extracellular edema, follows blood-brain barrier (BBB) breakdown; initially
                                                                  • CTE: Intracellular (closed barrier) edema; later
                                                                • Juvenile head trauma syndrome: Diffuse brain or hemispheric swelling after single trivial injury
                                                                  • Due to rapidly progressive reactive hyperemia

                                                              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. Griemert EV et al: Deficiency of plasminogen activator inhibitor type 2 limits brain edema formation after traumatic brain injury. J Neurotrauma.36(14):2272-8, 2019
                                                                                                  2. Hopp S et al: Alleviation of secondary brain injury, posttraumatic inflammation, and brain edema formation by inhibition of factor XIIa. J Neuroinflammation. 14(1):39, 2017
                                                                                                  3. Mckee AC et al: The neuropathology of traumatic brain injury. Handb Clin Neurol. 127:45-66, 2015
                                                                                                  4. Alves JL: Blood-brain barrier and traumatic brain injury. J Neurosci Res. 92(2):141-7, 2014
                                                                                                  5. 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
                                                                                                  6. Paiva WS et al: Delayed unilateral traumatic brain swelling in a child. J Pediatr Neurosci. 9(2):169-71, 2014
                                                                                                  7. Wu H et al: The diagnosis and surgical treatment of central brain herniations caused by traumatic bifrontal contusions. J Craniofac Surg. 25(6):2105-8, 2014
                                                                                                  8. 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
                                                                                                  9. 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
                                                                                                  10. Squier W et al: The pathophysiology of brain swelling associated with subdural hemorrhage: the role of the trigeminovascular system. Childs Nerv Syst. 28(12):2005-15, 2012
                                                                                                  11. Greve MW et al: Pathophysiology of traumatic brain injury. Mt Sinai J Med. 76(2):97-104, 2009
                                                                                                  12. 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
                                                                                                  13. Galloway NR et al: Diffusion-weighted imaging improves outcome prediction in pediatric traumatic brain injury. J Neurotrauma. 25(10):1153-62, 2008