Cerebral edema is a life-threatening condition that can cause permanent brain damage or death if not treated quickly. Typical signs of brain swelling include:
Headache, which is the most common symptom anytime the brain starts to swell, Dr. Balu saysDizzinessNauseaMood changes, such as depression, anxiety, or aggression as a result of a brain injuryMemory lossAltered consciousnessSeizureIntoxicationLack of coordinationIntestinal obstruction (volvulus, intussusception)Numbness or weakness that can be generalized or localizedDouble vision due to inability to fully move one of your eyes in a particular directionBulging in the soft spots of an infant’s skull
“Signs we look out for include increases in intracranial pressure in the head, sleepiness, responsiveness, and problems with vision,” Balu says. When a person is admitted to the hospital with a brain injury, sometimes neurologists will place a device directly into the brain itself to monitor intracranial pressure, Balu says. “Next, we’ll do a scan to see what’s causing the swelling and neurological symptoms and where it’s located,” he says. “We’ll either perform a CT scan or an MRI, but often we do MRIs, because they tell us more about the brain swelling and give us a picture of the type of neurological problem, whether it’s a stroke, bleeding, or tumor.” Those who are experiencing brain swelling should be closely monitored during the first 48 to 72 hours after the injury or infection. The speed at which a patient receives treatment can affect recovery time and improve outcome. If the cause is cytotoxic, doctors will look to reverse the underlying medical condition first with acute treatments, Balu says — for example, by starting an intravenous (IV) delivery of hypertonic saline that increases electrolytes in the blood and pulls water out of the brain. “Same for bleeding in the brain or TBI,” he says. “We don’t necessarily treat the swelling right away because it’s less of a concern. Though in extreme cases, we’ll have our colleagues do a craniectomy, where they take a portion of the skull off to let the brain swell out.” And if a patient comes in with acute symptoms of a stroke, Balu says they first work to get blood flow to the brain. Once cerebral edema has been diagnosed through a scan, a doctor may help relieve pressure by:
Keeping the hospital bed elevated 30 or 45 degrees. According to Balu, when the head is flat, it can increase pressure in the brain, so it’s best to keep the head up.Maintaining normal body temperature with antipyreticsMaintaining a calm environment with low lighting to avoid agitationMonitoring fluid and electrolyte levelsAdministering anticonvulsants for seizure preventionPrescribing pain relievers to increase comfortDraining CSF fluid by inserting a catheter into the ventricleAdministering neuromuscular blockadesOffering hyperosmolar therapy
In extreme cases, your doctor may consider a craniectomy to relieve pressure. Controlled hyperventilation, high-dose barbiturate therapy, and moderate hypothermia are other treatments to reduce swelling. Balu says an initial treatment of brain swelling is often a drug, such as:
Dexamethasone (Decadron)Mannitol (Aridol, Osmitrol)Acetazolamide (Diamox)Furosemide (Lasix)DiureticsCorticosteroids
Prevention of Cerebral Edema
Preventing cerebral edema involves taking measures to protect your head. Some options include:
Use a helmet during sports or physical activities to prevent brain injury.Control your blood pressure and cholesterol to prevent heart disease and stroke.Wear a seat belt when traveling in a vehicle.Slowly ascend to high elevations to avoid HACE.Avoid smoking to reduce the oxidative and inflammatory risk of stroke.
Vision lossHeadachesCerebral atrophyCognitive declineAltered mental statusDepressionSleep problemsEpilepsyIrreversible brain damage
According to a study published in 2018 in the Journal of Head Trauma Rehabilitation, the annual rate of emergency department visits for traumatic brain injuries is higher for Black Americans than for white Americans — 569 per 100,000 compared with 457 per 100,000, respectively. Black Americans also have higher rates of hospitalization due to brain injury. According to the Alzheimer’s Association, older adults with a history of moderate traumatic brain injury have a 2.3 times greater risk of developing Alzheimer’s than those with no history of brain injury. Those with a severe TBI have a 4.5 times greater risk. BIAA is a nonprofit organization dedicated to advancing awareness, research, education, and treatment, as well as improving the quality of life for all people with brain injuries. Get the essential facts about traumatic brain injuries and read personal stories from others who have been affected. American Stroke Association A division of the American Heart Association, the American Stroke Association funds research, advocates for public health policies, and works with volunteers across the country to prevent strokes and help people recover from them. Sign up for their newsletter to get the latest on stroke news and connect with a trained specialist on the Stroke Family Warmline who can provide support and helpful information about stroke.
Favorite Support Groups
Support Network — American Heart Association The American Heart Association offers a resource where you can find in-person support groups by zip code. Many groups have changed the format of their meetings to comply with social distancing and stay-at-home orders during the COVID-19 pandemic. You can also participate in online support groups and read stories from stroke survivors. Daily Strength Daily Strength is a free online support group for individuals with traumatic brain injury. Connect with others who understand and are going through the struggles of living with a TBI. PINK Concussions Women’s Group This private Facebook group is for women over the age of 25 who are suffering from a brain injury or post-concussion syndrome. Topics addressed include employment, relationships, and being a parent while living with a TBI.
Favorite Apps for Coping With Brain Injuries
Qcard QCard was designed by a brain injury survivor for other people living with brain injuries. Free on Android and iOS, it’s designed to “outsmart forgetfulness” and allows you to set reminders, appointments, lists, and guided tasks. Cozi This family management organizer offers shared calendars, reminders, and grocery lists. It can be extremely helpful to stay connected with loved ones, especially if you have multiple caregivers when you’re healing from a brain injury. Cozi is free on Android and iOS. Additional reporting by Ashley Welch.
