Cytotoxic edema: monitoring its magnitude and contribution to brain swelling.

Cytotoxic edema (CytE) is an increment in total brain water produced when the excess water swells cells rather than expanding the extracellular space. CytE contributes to brain swelling with a resultant increase of intracranial pressure (ICP). However, questions remain concerning the magnitude of the contribution made by CytE to raised ICP and the ability of CytE by itself to produce lethal levels of ICP that result in brainstem herniation. These questions exist because there are pitfalls in estimating the magnitude of CytE and hence its contribution to ICP using either electron microscopy or in vivo surrogates for CytE such as impedance measurements or the apparent diffusion coefficient. Correlation of these measures has been made during CytE. However, the literature provides reasons to question whether any of these surrogates for CytE can give accurate quantitative measures of CytE. At present, there is little evidence to indicate that CytE can, by itself, raise ICP to lethal levels. However, because CytE can raise ICP, it is of interest to develop treatments to prevent or reduce CytE even though currently available data do not yet provide an established mechanistic basis upon which to base such therapy.