Acute therapeutic modalities for experimental vasogenic edema

Abstract

Experimental vasogenic cerebral edema was created in rabbits with a cold-induced left occipital cortical lesion. Intracranial pressure (ICP), intracranial elastance (Em), water content, hemispheric brain tissue volume, electrolytes, electroencephalograms, behavior, and gross pathology were studied. Various therapeutic modalities were employed alone or in combination to reduce ICP acutely: acetazolamide, furosemide, mannitol, pentobarbital, lorazepam, and dexamethasone. All therapies except dexamethasone were effective in reducing ICP. Peak ICP reduction occurred at 27 ± 9.8 (SD) minutes with mannitol and at 71.4 ± 15.5 minutes with acetazolamide, with the remaining agents and combinations falling between these two extreme values. Em improved by 31.7 ± 17.02% in all therapeutic trials except those employing acetazolamide and lorazepam. With therapy, there was a reduction in the water content of the hemispheres, but the difference from that in the untreated, lesioned animals was not statistically significant. In the lesioned left hemisphere, sodium content was increased by acetazolamide (p < 0.005), furosemide (p < 0.025), pentobarbital (p < 0.05), and the combination of dexamethasone, pentobarbital, and mannitol (p < 0.005), Significant reduction was noted in the lesioned group for the potassium content of the left hemisphere in the dexamethasone (p < 0.05), pentobarbital (p < 0.025), and combination groups containing these agents (p < 0.005 to 0.025), (Neurosurgery, 5: 656-665, 1979)