Brain Swelling, Part 2: Diagnosis and Treatment

As discussed in a previous blog, brain swelling is essentially similar to swelling of any other part of the body; it is the accumulation of fluid at or near a site of brain injury, infection or disease. However, the implications of it are far more serious.

Because the brain is enclosed within the skull, the cause of suspected brain swelling might not be readily ascertainable. Therefore, depending upon the expressed or observed symptoms, there are some other ways to diagnose brain swelling. These include:

• A head and neck examination: to detect a spinal cord injury. From the standpoint of brain swelling, a secondary effect of a spinal cord injury is that in the first few months after such an injury, blood clots can develop within the spinal cord or within the arteries that supply the spinal cord with blood. Frequently, it is caused by a specific form of arteriosclerosis, called “atheromatosis.” Those clots can cause brain swelling;
• A neurologic examination;
• A computerized tomography scan (CT) of the head: to determine the precise location and degree of swelling. It is essentially a series of x-rays that are taken from many different angles. All of the x-rays are then processed by a computer that creates a cross-sectional view of the part(s) of the body that were scanned. The radiologist who “reads” the CT scan can look at the “slices” individually or as a whole. By looking at it, or in combination with another kind of visualization, he/she can determine whether there exists a brain tumor or another cause of the brain swelling;
• A magnetic resonance imaging scan (MRI) of the head is performed for essentially the same reasons as a CT scan. It is a test similar to the CT and is a complementary tests. Each has attributes and limitations, depending on the working diagnosis, but the CT scan is more commonly done. One of the primary distinctions between the tests is that there is anecdotal, but disputed, evidence that there is a slightly greater incidence of cancer resulting from CT scans than with the MRI test[1]. An MRI can be done with or without “contrast.” The “contrast” is an iodine-based solution that is injected intravenously before the scan, allowing time for it to circulate throughout the body to facilitate the visualization of any obstruction or abnormality of the part of the body being scanned;
• Blood tests to determine if there are infectious or viral issues causing the swelling. A fairly uncommon but serious condition that causes inflammation of the brain is encephalitis. Encephalitis can be viral, infectious, post-infectious, autoimmune or chronic. Regardless of the type, it causes inflammation of the brain. It may begin with flu-like symptoms and is evidenced by a change in mental state, seizures and changes in personality or behavior. Encephalitis is treated with anti-viral medication, steroids, or immunosuppressants. Although many people recover from it, encephalitis can result in memory loss, seizures and other abnormalities[2].

Brain swelling can be treated by various modalities. Relatively minor cases of brain swelling (such as those caused by high altitude) often resolve themselves without intervention. If they do not, additional treatment should be obtained quickly. The goal of all treatment is to ensure the brain gets sufficient blood and oxygen to remain healthy while underlying causes are determined and cured. Fast and ongoing care is needed to reduce the chance of residual damage. If needed, the following types of care may be needed:

• Oxygen therapy to ensure that the blood is sufficiently oxygenated;
• Intravenous fluids to ensure that blood pressure remains sufficiently high. Since blood flows to the brain, it is imperative that the brain receives enough blood. Some fluids can cause the swelling increase, so a balance must be reached between the proper fluid and the proper amount of it;
• Lowering body temperature may assist in relieving swelling;
• Medication may be given to relieve the swelling, to alter the body’s reaction to the swelling, to dissolve clots or for other reasons. The drugs prescribed will correlate with the cause of the swelling.
• Surgery of various types to relieve pressure by draining fluid or removing or repairing a damaged artery, vein or growth.

NeuLife’s skilled team of professionals is uniquely positioned provide specialized rehabilitation and superior care and educate the client and family to achieve the highest and best level of function consistent with his/her medical or neurological conditions.