malignant cerebral oedema
malignant cerebral oedemaAn uncommon, often fatal complication of traumatic brain injury, which is more common in children and adolescents. It is diagnosed by a rapid increase in intracranial pressure shortly after injury, is refractory to medical management, and attributed to global cytotoxic oedema due to activation of apoptotic pathways and failure of energy metabolism.
Multi-modality neuromonitoring, osmotic diuretics, CSF drainage via an extraventricular drain, sedation and paralytics, avoid hyponatremia; pCO2 should be maintained at the low end of the normal 35–45 mm Hg range, and intracranial pressure maintained at < 20 mm Hg.
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