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Brain Edema: From Molecular Mechanisms to Clinical Practice brings together the most widely recognized experts in experimental and clinical brain edema research to review the current knowledge gathered on the molecular and cellular pathophysiology and clinical management of brain edema. This timely book also discusses future directions of research and treatment. Brain edema is an integral and acutely life-threatening part of the pathophysiology of multiple cerebral and non-cerebral disorders, including traumatic brain injury, cerebral ischemia, brain tumors, cardiac arrest, altitude sickness and liver failure. Affecting millions worldwide, research over the past few years has shown that a plethora of complex molecular and cellular mechanisms contribute to this pathological accumulation of water in the brain parenchyma. In parallel, the development of new neuroimaging tools has provided a new way to examine how edema develops longitudinally and in real time, both in pre-clinical models and in patients. Despite intense research over the past few decades, therapeutic options are still limited and sometimes not effective. - Presents a comprehensive understanding of the molecular mechanisms involved in edema formation and resolution - Discusses the specific role of edema development in several pathologies, including traumatic brain injury, stroke, brain tumors, cardiac arrest, and liver failure - Proposes a new classification of edema based on molecular processes - Discusses clinical management of new clinical trials coming from pre-clinical studies - Addresses the possible link between edema formation, other molecular and cellular processes, including inflammation and neuroinflammation
Brain edema is a simple phenomenon – an abnormal increase of brain tissue volume by the increase of brain tissue water content. However the etiology is not simple and relating to a wide variety of neurological disorders including ischemia, trauma, tumor, hemorrhage and hydrocephalus. It is still a major cause of death in the neurological/neurosurgical ward. This volume is an up-to-date report on progress in brain edema research, diagnosis and treatment, including papers presented at the 12th International Symposium on Brain Edema and Brain Tissue Injury in 2002. Major topics include molecular biology and blood-brain barrier disorders, ischemic and traumatic brain edema, imaging and diagnosis of brain edema, treatment and radiation effect. Various papers in the rapidly growing fields of neuroimaging and molecular medicine are also included.
The experimental brain edema as a result of application of numerous different toxic agents has been the subject of a large number of publications (for synopses see Hirano, 1969; Long et al. , 1965). A concept that took the underlying causes of the lesions as the basis for classification of different types of brain edema was presented by Klatzo (1967). In this classification Klatzo differentiates between cytogenic and vasogenic causes of brain edema that are distinguishable from each other by the differing behaviour and reaction of the blood-brain-barrier. The vasogenic type of brain edema is found mostly in the vicinity of tumors, traumata and foci of infections, presumably because of an alteration of the conditions of permeability, as well as in brain edemas that are caused by changes in the hemodynamics of the central nervous system, and toxic substances that act directly on the wall of the blood vessel. The cytogenic type of brain edema in many experimental models is the result of, for instance, TET-intoxication, water intoxication, poisoning with other chemical substances and anoxia. Its direct cause according to Klatzo (1967) is to be seen in a disturbance of the intra cellular osmoregulation of the parenchymal cells. Although the composition of the edema fluid is dependent on the type of toxic substance used, the lack of plasma proteins in the edema fluid is characteristic for the brain edemas of this group.
The brain is the most complex organ in our body. Indeed, it is perhaps the most complex structure we have ever encountered in nature. Both structurally and functionally, there are many peculiarities that differentiate the brain from all other organs. The brain is our connection to the world around us and by governing nervous system and higher function, any disturbance induces severe neurological and psychiatric disorders that can have a devastating effect on quality of life. Our understanding of the physiology and biochemistry of the brain has improved dramatically in the last two decades. In particular, the critical role of cations, including magnesium, has become evident, even if incompletely understood at a mechanistic level. The exact role and regulation of magnesium, in particular, remains elusive, largely because intracellular levels are so difficult to routinely quantify. Nonetheless, the importance of magnesium to normal central nervous system activity is self-evident given the complicated homeostatic mechanisms that maintain the concentration of this cation within strict limits essential for normal physiology and metabolism. There is also considerable accumulating evidence to suggest alterations to some brain functions in both normal and pathological conditions may be linked to alterations in local magnesium concentration. This book, containing chapters written by some of the foremost experts in the field of magnesium research, brings together the latest in experimental and clinical magnesium research as it relates to the central nervous system. It offers a complete and updated view of magnesiums involvement in central nervous system function and in so doing, brings together two main pillars of contemporary neuroscience research, namely providing an explanation for the molecular mechanisms involved in brain function, and emphasizing the connections between the molecular changes and behavior. It is the untiring efforts of those magnesium researchers who have dedicated their lives to unraveling the mysteries of magnesiums role in biological systems that has inspired the collation of this volume of work.
A workshop on Dynamic Aspects of Cerebral Edema was organized to pro vide an opport~nitY,for interdisciplinary and detailed consideration of this subject, so crucial in neurology and neurosurgery. The previ ous workshops were held in Vienna in 1965 and in Mainz in 1972. In the meantime, our ideas on mechanisms of resolution of cerebral edema had been changing drastically. Controversy had arisen regarding the role of biogenic amines in the development of edema. Active work in several centers had indicated the possibility of a reversible compo nent in edematous changes associated with ischemia, the control of which could be of therapeutic significance in the problem of stroke. It was felt that a thorough discussion, at this time, by those involv ed in these various studies should help to resolve the controversies, to crystallize the implications of the new findings, and to evaluate their application for patient care. In preparing the proceedings for publication we have edited the manu scripts and selected the discussions with an aim to highlight new find ings, to make this volume readable, and to eliminate duplication. We gratefully acknowledge financial support from the institutions and organizations previously listed. Many individuals contributed to the success of the workshop and the preparation of the proceedings for publication. Doctors J.B. Brierley, I. Klatzo, H.J. Reulen, and A.G.
Traumatic brain injury (TBI) remains a significant source of death and permanent disability, contributing to nearly one-third of all injury related deaths in the United States and exacting a profound personal and economic toll. Despite the increased resources that have recently been brought to bear to improve our understanding of TBI, the developme
This volume contains the papers presented at the 24th Annual Meeting of the Deutsche Gesellschaft fur Neurochirurgie, held in Mainz, Western Germany, on April 30 - May 3, 1973. Deliberate choice was made of two crucial still hotly debated subjects which, for ages, have meant a source of constant worry, and nights without sleep to every neurosurgeon. Just as long as our special field exists, there have been the problems of how to control brain edema and ·of how to reduce lethality and the secondary lesions in surgery of cerebello-pontine angle tumors. Concerning the first subject, new pathological, pathophysiological and chemical aspects, the mechanisms of brain edema formation and resolution are presented in the hope for better understanding. Furthermore, the relationship between brain edema, intracranial pressure, cerebral blood flow and metabolism are discussed. Finally, the therapeutical consequences as well as the results of experimental and clinical work are presented, and a comparison of effects between different methods (hypertonic solutions, diuretics, steroids, controlled hyperventilation, hyperbaric oxygen) is given. Concerning the second main subject, any important contributions to the early diagnosis of cerebello-pontine angle tumors have been included. Nevertheless, it is of utmost interest for the neurosurgeon to know which approach he is to prefer for the different stages of tumor size and to be familiar with the trans labyrinthine approach or the posterior craniotomy, as well as with the importance of the use of the microscope in neurosurgery, the preservation of the facial nerve and, in certain cases, its repair.
The aquaporin field has matured at an exceptionally fast pace and we are at the verge to develop serious strategies to therapeutically modulate aquaporin function directly or via regulatory networks. Key prerequisites are available today: i. a considerable (and growing) number of aquaporin crystal structures for the rational design of inhibitory molecules, ii. elaborate molecular dynamics simulation techniques for theoretical analyses of selectivity mechanisms and docking experiments, iii. comprehensive data on aquaporin immunohistochemistry, iv. aquaporin knockout animals for physiological studies, and v. assay systems for compound library screenings. The structure of this volume on aquaporins follows the points laid out above and thus covers the developments from basic research to potential pharmacological use. Situated between pharmacology textbooks and recent scientific papers this book provides a timely overview for readers from the fundamental as well as the applied disciplines.
This e-book will review special features of the cerebral circulation and how they contribute to the physiology of the brain. It describes structural and functional properties of the cerebral circulation that are unique to the brain, an organ with high metabolic demands and the need for tight water and ion homeostasis. Autoregulation is pronounced in the brain, with myogenic, metabolic and neurogenic mechanisms contributing to maintain relatively constant blood flow during both increases and decreases in pressure. In addition, unlike peripheral organs where the majority of vascular resistance resides in small arteries and arterioles, large extracranial and intracranial arteries contribute significantly to vascular resistance in the brain. The prominent role of large arteries in cerebrovascular resistance helps maintain blood flow and protect downstream vessels during changes in perfusion pressure. The cerebral endothelium is also unique in that its barrier properties are in some way more like epithelium than endothelium in the periphery. The cerebral endothelium, known as the blood-brain barrier, has specialized tight junctions that do not allow ions to pass freely and has very low hydraulic conductivity and transcellular transport. This special configuration modifies Starling's forces in the brain microcirculation such that ions retained in the vascular lumen oppose water movement due to hydrostatic pressure. Tight water regulation is necessary in the brain because it has limited capacity for expansion within the skull. Increased intracranial pressure due to vasogenic edema can cause severe neurologic complications and death.
Brain edema is found in a wide variety of clinical disorders including stroke, intracerebral haemorrhage, subarachnoid haemorrhage, head injury, brain tumors and hydrocephalus. This volume brings together clinical and basic scientists from all over the world. Their expertise in the understanding of brain edema and shifts in brain water compartments has led to a further significant step in our understanding of those diseases characterized by brain edema. This book has also drawn on the expertise of the International Advisory Board of the Brain Edema Society, who have carefully summarized each section, thus providing an easy-to-read summary of the latest advances in each subject. The book is therefore much more than a collection of papers: it represents a critical appraisal and puts each paper into modern scientific context. The greatest advances have come from the rapid development of modern imaging techniques, especially with magnetic resonance imaging (MRI). Imaging can now produce "water maps” and "metabolic profiles” that bring brain metabolism and water content right into every clinic with access to MRI. This book provides the background knowledge to understand these pathophysiological changes.