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Vasogenic cerebral edema

Swelling from fluid accumulation in brain extracellular space due to blood-brain barrier disruption Pathophysiology: Tumors/masses/abscesses → BBB disruption → protein-rich fluid leaks into white matter Uncontrolled HTN → endothelial damage → BBB permeability increases Inflammation → capillary disruption → fluid extravasation Monro-Kellie Doctrine: Fixed intracranial volume = brain + blood ↑ in one component → ↓ in others → potential CBF compromise Diagnostic Features: MRI findings: T2 hyperintensity without diffusion restriction Predominantly affects white matter Primary treatment: Dexamethasone → reduces capillary permeability + inflammatory mediators Supportive measures: Controlled hyperventilation Sedation Diuresis Definitive: Treat underlying cause Steroids ineffective for cytotoxic edema: may worsen outcomes through hyperglycemia / hypertension