Malignant cerebral edema and intracranial hypertension

Cerebral edema and intracranial hypertension occur frequently in neurologic patients. Proper understanding of the pathophysiology of each entity allows prompt recognition and rational therapeutic goals, allowing for better neurologic outcome in many disease states. The recognition of cerebral edema as a distinct entity allows the clinician to treat focal pressure gradients in the brain separately from more diffuse intracranial pressure elevations, appreciating the benefits and pitfalls of directed therapies for each process. The treatment of many of the disorders that cause cerebral edema and intracranial hypertension is heuristic, challenging the managing physician's thorough understanding of cerebral hemodynamics and his or her ability to encounter the human aspects of determining appropriate levels of care for individual patients.