Pathophysiology and treatment of cerebral edema in traumatic brain injury
Year: 2018
Type: review
Abstract: Cerebral edema (CE) and resultant intracranial hypertension are associated with unfavorable prognosis in traumatic brain injury (TBI). CE is a leading cause of in-hospital mortality, occurring in >60% of patients with mass lesions, and ∼15% of those with normal initial computed tomography scans. After treatment of mass lesions in severe TBI, an important focus of acute neurocritical care is evaluating and managing the secondary injury process of CE and resultant intracranial hypertension. This review focuses on a contemporary understanding of various pathophysiologic pathways contributing to CE, with a subsequent description of potential targeted therapies. There is a discussion of identified cellular/cytotoxic contributors to CE, as well as mechanisms that influence blood-brain-barrier (BBB) disruption/vasogenic edema, with the caveat that this distinction may be somewhat artificial since molecular processes contributing to these pathways are interrelated. While an exhaustive discussion of all pathways with putative contributions to CE is beyond the scope of this review, the roles of some key contributors are highlighted, and references are provided for further details. Potential future molecular targets for treating CE are presented based on pathophysiologic mechanisms. We thus aim to provide a translational synopsis of present and future strategies targeting CE after TBI in the context of a paradigm shift towards precision medicine. This article is part of the Special Issue entitled "Novel Treatments for Traumatic Brain Injury".
Source: Neuropharmacology
Institutions: University of Pittsburgh, University of Maryland, Baltimore
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,300
Awards: Fn14, non-canonical NF-kappaB and downstream signaling in neuropathic pain, G1980181314, 2,3 cAMP in Traumatic Brain Injury, Non-canonical NF-kappaB signaling and Sur1-Trpm4 in traumatic brain injury, G3706036739, G5295068808, Astrocyte regulation of the blood-brain barrier in intracerebral hemorrhage, Translational assessment of sulfonylurea receptor-1 as a biomarker and therapeutic target for cerebral edema in traumatic brain injury, G878158308, Spinal cord injury, progressive hemorrhagic necrosis and the NC(Ca-ATP) channel, Pediatric Neurointensive Care and Resuscitation Research
OpenAlex ID: W2886166995