Post-Traumatic Cerebral Edema: Pathophysiology, Key Contributors, and Contemporary Management

Abstract

The development of cerebral edema following traumatic brain injury is one of the most significant predictors of outcome and is associated with high rates of morbidity and mortality. A prominent focus of neurosurgical and neurocritical care is the evaluation and aggressive management of cerebral edema and subsequent intracranial hypertension. Despite numerous advances and capabilities in neurocritical care, treatments remain primarily reactive and are instituted only after secondary pathophysiological pathways have culminated in an intracranial pressure crisis. Recent reviews have focused on several key molecular contributors to post-traumatic cerebral edema and on several potential anti-edema therapeutic targets. The present article provides a contemporary overview of post-traumatic cerebral edema by reviewing important historical concepts, fundamental pathophysiological mechanisms, various causes and key contributors specific to traumatic brain injury, and established treatments of downstream intracranial hypertension.