Cerebral Edema in Neurocritical Patients: Diagnosis, Monitoring, and Management

Cerebral edema is a severe and often life-threatening complication in neurocritical patients, commonly arising from traumatic brain injury, ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. It contributes to elevated intracranial pressure, impaired cerebral perfusion, and worsened neurological outcomes.

This literature review aims to consolidate current knowledge regarding the mechanisms, diagnostic tools, monitoring strategies, and therapeutic approaches for cerebral edema in neurocritical care.

An extensive search of scientific databases, including PubMed, Scopus, and Web of Science, was conducted for literature published from 2010 to 2024. Selection criteria focused on clinical trials, guidelines, and high-quality reviews addressing cerebral edema in intensive neurological settings.

Diagnosis relies primarily on neuroimaging techniques (CT and MRI), intracranial pressure monitoring, and clinical assessment. Novel non-invasive methods such as optic nerve sheath diameter ultrasonography and brain tissue oxygenation monitoring are gaining clinical interest. Management strategies include hyperosmolar therapy, controlled ventilation, sedation, temperature regulation, and in select cases, decompressive craniectomy. Despite advancements, individualized treatment protocols and consensus on ICP thresholds remain areas of active investigation.

Cerebral edema represents a dynamic and multifactorial process requiring timely recognition and a multimodal treatment approach. Continuous evolution in monitoring technologies and therapeutic strategies holds promise for improving outcomes in neurocritical patients.