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Definition: Excess accumulation of water in the intra- and/or extracellular spaces of the brain.
The disruption of the cerebral capillary provides the underlying mechanism for vasogenic edema. The amount of edema is greatest in the white matter (increased water and sodium in the extracellular spaces, decreased potassium); but the same changes may take place in grey matter but less so. The astrocytes become swollen. This type of edema is seen in response to trauma, tumors, focal inflammation, and late stages of cerebral ischemia.
This is due to the derangement in cellular metabolism resulting in inadequate functioning of the sodium and potassium pump in the glial cell membrane. As a result there is cellular retention of sodium and water. There are swollen astrocytes in grey and white matter. Cytoxotic edema is seen with various intoxications (dinitrophenol, triethyltin, hexachlorophene, isoniazid) and in Reye's syndrome, severe hypothermia, and early ischemia.
Normally CSF and ECF osmolality in the brain is slightly greater than that of plasma. When plasma is diluted by SIADH, water intoxication, hemodialysis, there is passage of water down abnormal gradient creating cerebral edema.
This form of cerebral edema is seen in acute, malignant hypertension. It is thought to result from direct transmission of pressure to cerebral capillary with transudation of fluid into the ECF.
Pathophysiology of Cerebral Edema:
This is a cascade of events involving loss of the integrity of the BBB, setting up of a vascular hydrostatic gradient, increased tissue pressure, decreased cerebral blood flow, with resulting tissue acidosis. Chemical changes include glutamate, serotonin, components of kallikrein-kininogen-inin, fatty acids
Surgical removal of offending lesion
Control of arterial blood pressure
Corticosteroids - stabilize membranes
Osmotherapy - mannitol (1 g/kg); lasix 0.7 mg per kg; glycerol 1 g/kg
Control of ICP - carbonic anhydrase, DMSO
Death, "by misadventure"
Bruce Lee's death was officially attributed to cerebral edema.
On July 20, 1973, Lee was in Hong Kong, due to have dinner with former James Bond star George Lazenby, with whom he intended to make a film. According to Lee's wife, Linda, Bruce met producer Raymond Chow at two p.m. at home to discuss the making of the movie Game of Death. They worked until four p.m., and then drove together to the home of Betty Ting Pei (丁珮), a Taiwanese actress and Bruce Lee's alleged mistress, who was to have a leading role in the film. The three went over the script at her home, and then Chow left to attend a dinner meeting.
A short time later, Lee complained of a headache, and Ting Pei gave him an analgesic. At around 7:30 p.m., he lay down for a nap. After Lee didn't turn up for the dinner, Chow came to the apartment but could not wake Lee up. A doctor was summoned, who spent ten minutes attempting to revive him before sending him by ambulance to Queen Elizabeth Hospital. However, Lee was dead by the time he reached the hospital. There was no visible external injury; however, his brain had swollen considerably, from 1,400 to 1,575 grams. Lee was thirty two years old. On October 15, 2005, Chow stated in an interview that Lee was allergic to Equagesic, an analgesic formulation containing meprobamate, aspirin and ethoheptazine. When the doctors announced Bruce Lee's death officially, it was coined as "Death by Misadventure".
However, the exact details of Lee's death are controversial. Bruce Lee's iconic status and unusual death at a young age led many people to develop many theories about Lee's death, such as a murder involving an ancestral curse, triads, gangsters, sudden death in epilepsy and so on — none of these have ever been proven. At the 2006 meeting of the American Association for the Advancement of Science, Dr James Filkins of Cook County medical examiner's office in Chicago suggested that Lee had died from Sudden Unexpected Death In Epilepsy (SUDEP), a syndrome only recognised in 1995