Cerebral Edema: Pathophysiology and Principles of Management

Abstract

Edema, while often benign elsewhere in the body, is almost always of clinical ­significance when it occurs within the cranial vault. Unlike nearly every other tissue area, the cranium is uniquely intolerant to any change in mass, no matter how insignificant that change may be. The classical thinking of the inhabitants of the cranium and the resultant pressure created by their presence is defined by the Monroe-Kellie Doctrine. Tissue cells, blood, and cerebrospinal fluid (CSF) maintain a consistent presence within the cranium and spinal cord areas. When any single component increases, the other two have a limited capacity to shift into accessory spaces so as to avoid a rise in intracranial pressure.