1. Krane: DKA And Cerebral Edema Elliot J. Krane, M.D. Departments of Pediatrics and Anesthesiology. Stanford University Medical Center. Contents. Introduction. Clinical Characteristics of cerebral edema Complicating DKA. The Osmotic Abnormalities in DKA later the first reported case of cerebral edema complicating diabetic ketoacidosis (DKA) was reported by While the syndrome of cerebral edema complicating DKA was either not seen http://pedsccm.wustl.edu/FILE-CABINET/Metab/DKA-CEdema.html

Diabetic Ketoacidosis and Cerebral Edema Elliot J. Krane, M.D. Departments of Pediatrics and Anesthesiology Stanford University Medical Center Contents Introduction Clinical Characteristics of Cerebral Edema Complicating DKA The Osmotic Abnormalities in DKA Overhydration and Hyponatremia During DKA ... Suggested Readings Introduction In 1922 Banting and Best introduced insulin into clinical practice. A decade later the first reported case of cerebral edema complicating diabetic ketoacidosis (DKA) was reported by Dillon, Riggs and Dyer writing in the pathology literature. While the syndrome of cerebral edema complicating DKA was either not seen, ignored, or was unrecognized by the medical community until 3 decades later when the complication was again reported by Young and Bradley at the Joslin Clinic, there has since been a flurry of case reports in the 1960's and 1970's and basic and clinical research from the 1970's to the 1990's leading to our present day acceptance of this as a known complication of DKA, or of the management of DKA. In fact, we now recognize that the cerebral complications of DKA (including much less frequent cerebral arterial infarctions, venous sinus thrombosis, and central nervous system infections) are the most common cause of diabetic-related death of young diabetic patients (

2. Cerebral Edema cerebral edema. cerebral edema. Ultimately, these changes can lead to herniation.BRAIN HERNIATION. Is a major consequence of cerebral edema. http://edcenter.med.cornell.edu/CUMC_PathNotes/Neuropathology/Neuropath_I/edema.

Cerebral Edema Cerebral Edema Intracellular (Cytotoxic) edema Cellular swelling, usually of astrocytes in the grey matter, and classically is seen following cerebral ischema caused by cardiac arrest or minor head injury. The blood brian barrier(BBB) is intact. Intracellular edema is usually not clinically significant, and is reversible in its early phases. Extracellular (vasogenic) edema A consequence of vascular injury with disruption of the BBB. Grossly , the gyri are flattened and the sulci narrowed; the white matter is moist and swollen. Microscopically, there is micro-vacuolization of the white matter, poor staining, and "halo's" around nuclei. Causes include trauma, tumor, and abscess. Ultimately, these changes can lead to herniation. BRAIN HERNIATION Is a major consequence of cerebral edema. Because of the rigid skull and partitioning of the cranial vault by the falx cerebri and tentorium cerebelli, when the brain swells it is displaced relative to these partitions or is pushed toward the foramen magnum. There are several types of brain herniations - classified by the part that is herniated or the structure under which it has been pushed. Transtentorial herniations are of two main types: Uncal herniation The medial temporal lobe (uncus) herniates through the gap between the cerebral peduncles and the tentorium.

3. Cerebral Edema A definition, classifications, pathophysiology and treatment of cerebral edema. http://brainavm.uhnres.utoronto.ca/staff/Wallace/2000_curriculum/cerebral_edema.

MENU Home For Patients For Professionals Who We Are ... back MENU Home For Patients For Professionals Who We Are ... Contact Us Cerebral Edema The Blood Brain Barrier (BBB): The cerebral capillary is the site of the BBB. Interendothelial tight junctions impede the passage of electron-dense markers. Cerebral capillaries lack fenestrations and have tight junctions. They are active in the process of pinocytosis. All these features regulate the passage of highly polar hydrophilic molecules allowing virtually unrestricted passage of lipid-soluble substances. Cerebral capillaries have 2-4X the number of mitochondria as other capillaries. Cerebral capillaries have an array of important enzymes: ATPase, dehydrogenase, monamine oxidase, DOPA decarboxylase, acid and alkaline phosphatase, NAD and others. BBB has both central (cholinergic and aminergic) and peripheral (sympathetic and parasympathetic) innervation. Areas without a BBB include: choroid plexus area postrema median eminence neurohypophysis pineal body subforniceal organ commissural organ supra-optic crest.

4. Baylor Neurology Case Of The Month presentations of multiple sclerosis could exhibit cerebral edema and white matter lesions together with a of cranial nerve deficits and cerebral edema in this patient also make http://www.bcm.tmc.edu/neurol/challeng/pat48/summary.html

Patient #48 Summary and Discussion Jennifer Lynch, MD and Dennis R. Mosier, MD, PhD Diagnosis: Systemic lupus erythematosus with cerebral edema and leukoencephalopathy Hospital Course: She returned to the Ben Taub emergency room two days later with tachypnea, and was readmitted to the hospital with left ear pain, dizziness, tachycardia (to 120/min), and progressive hypoxemia. Records of her recent "pneumonia" (not available on the first admission) described considerable pleuritic chest pain, with no causative organisms isolated. Her condition rapidly declined, and she was intubated for mechanical ventilation, with bright red blood evident upon initial suctioning. Bronchoscopy was performed, but did not detect any sites of ongoing bleeding, and no growth of bronchial washings or atypia of cells was found. The patient had been empirically treated with valacyclovir in view of her history of herpes simplex, but no conclusive evidence of viral infection was found. Together with the clinical or historical features of CNS dysfunction, episodic polyarthralgias, anemia of chronic disease

5. ClinicalPoints® Treatments, diagnosis and key points for cerebral edema. http://mdx.com/products/demos/webready/Professional/ClinicalPoints/data_002.html

6. Cerebral Edema water intoxication, hemodialysis, there is passage of water down abnormal gradient creating cerebral edema. Pathophysiology of cerebral edema This is a cascade of events involving http://www.brainavm.uhnres.utoronto.ca/staff/Wallace/2000_curriculum/cerebral_ed

MENU Home For Patients For Professionals Who We Are ... back MENU Home For Patients For Professionals Who We Are ... Contact Us Cerebral Edema The Blood Brain Barrier (BBB): The cerebral capillary is the site of the BBB. Interendothelial tight junctions impede the passage of electron-dense markers. Cerebral capillaries lack fenestrations and have tight junctions. They are active in the process of pinocytosis. All these features regulate the passage of highly polar hydrophilic molecules allowing virtually unrestricted passage of lipid-soluble substances. Cerebral capillaries have 2-4X the number of mitochondria as other capillaries. Cerebral capillaries have an array of important enzymes: ATPase, dehydrogenase, monamine oxidase, DOPA decarboxylase, acid and alkaline phosphatase, NAD and others. BBB has both central (cholinergic and aminergic) and peripheral (sympathetic and parasympathetic) innervation. Areas without a BBB include: choroid plexus area postrema median eminence neurohypophysis pineal body subforniceal organ commissural organ supra-optic crest.

7. Cerebral Edema In DKA References cerebral edema in DKA References. Mel, JM and Werther, GA Incidence and outcomeof diabetic cerebral oedema in childhood are there predictors? http://pedsccm.wustl.edu/FILE-CABINET/Metab/DKA_refs.html

Cerebral edema in DKA References abstract abstract Rosenbloom, A. L. Intracerebral crises during treatment of diabetic ketoacidosis. Diabetes Care 13: 22-33, 1990. [[ abstract Harris, G. D., Fiordalisi, I., Harris, W. L., Mosovich, L. L. and Finberg, L. Minimizing the risk of brain herniation during treatment of diabetic ketoacidemia: a retrospective and prospective study [published erratum appears in J Pediatr 1991 Jan;118(1):166-7] [see comments]. Journal of Pediatrics 117: 22-31, 1990. [ abstract abstract Duck, S. C. and Wyatt, D. T. Factors associated with brain herniation in the treatment of diabetic ketoacidosis. Journal of Pediatrics 113: 10-14, 1988. [ abstract Hoffman, W. H., Steinhart, C. M., el, G. T., Steele, S., Cuadrado, A. R. and Morse, P. K. Cranial CT in children and adolescents with diabetic ketoacidosis. Ajnr: American Journal of Neuroradiology 9: 733-9, 1988. [ abstract Krane, E. J., Rockoff, M. A., Wallman, J. K. and Wolfsdorf, J. I. Subclinical brain swelling in children during treatment of diabetic ketoacidosis. New England Journal of Medicine 312: 1147-51, 1985. [ abstract Also see: Fluid Resuscitation In Diabetic Ketoacidosis- Literature Review . Fisher JD. 1998. The Completely Different Pediatric Emergency Medicine Journal Back to File Cabinet Index Document last modified July 2, 1998

8. CEREBRAL EDEMA IN HEPATIC FAILURE Slide 1, Article 2. Rovira, et al. cerebral edema IN HEPATIC FAILURE water content of the whole brain. This cerebral edema is a major cause of intracraneal hypertension and The rarity of cerebral http://foundation.asnr.org/neurographics/Rovira/3.asp

9. Cerebral Edema - Information / Diagnosis / Treatment / Prevention home neurological disorders brain diseases cerebral edema cerebral edema. ClinicalPoints® Treatments, diagnosis and key points for cerebral edema. http://www.healthcyclopedia.com/neurological-disorders/brain-diseases/cerebral-e

Home Health cyclopedia All Topics by Category The Good Health Search Engine Health Conditions A-Z Gurus ... brain diseases > cerebral edema Cerebral Edema Information / Diagnosis / Treatment / Prevention External links (marked with an arrow ) open in a new window. This site is a web directory and does not offer medical advice. We cannot take responsibility for information found on listed sites. This Page Medical Definition Health News Web Directory: Medical Definition: University of Newcastle-upon-Tyne Medical Dictionary: "cerebral oedema" Health News: Search millions of published articles for news on Cerebral Edema Modern Medicine Aging The Ardell Wellness Report HealthFacts Medical Post Medical Update Men's Health and the National Women's Health Report Note: Subscription required to access the full text of articles. Web Directory: Brain Swelling and Edema An article with a description of these conditions. ClinicalPoints® Treatments, diagnosis and key points for cerebral edema. The Toronto Brain Vascular Malformation Study Group A definition, classifications, pathophysiology and treatment of cerebral edema. Notes: Healthcyclopedia presents health information in the form of websites and articles that encompass conventional medicine and alternative treatments Under no circumstances can it recommend or endorse a specific drug or therapy or treatment.

10. NEJM -- Risk Factors For Cerebral Edema In Children With Diabetic Ketoacidosis Original Article from The New England Journal of Medicine Risk Factors for cerebral edema in Children with Diabetic Ketoacidosis A comparison of the children in the cerebraledema groupwith those in the random control group showed that cerebraledema was significantly associated with lower http://www.nejm.org/cgi/content/abstract/344/4/264

HOME SEARCH CURRENT ISSUE PAST ISSUES ... HELP Please sign in for full text and personal services Previous Volume 344:264-269 January 25, 2001 Number 4 Next Risk Factors for Cerebral Edema in Children with Diabetic Ketoacidosis Nicole Glaser, M.D., Peter Barnett, M.B., B.S., Ian McCaslin, M.D., David Nelson, M.D., Jennifer Trainor, M.D., Jeffrey Louie, M.D., Francine Kaufman, M.D., Kimberly Quayle, M.D., Mark Roback, M.D., Richard Malley, M.D., Nathan Kuppermann, M.D., M.P.H., for The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics Full Text PDF Editorial by Dunger, D. B. ... Chapters at Harrison's ABSTRACT Background Cerebral edema is an uncommon but devastating complication of diabetic ketoacidosis in children. Risk factors for this complication have not been clearly defined. Methods In this multicenter study, we identified 61 children who had been hospitalized for diabetic ketoacidosis within a 15-year period and in whom cerebral edema had developed. Two additional groups of children with diabetic ketoacidosis but without cerebral edema were also identified: 181 randomly selected children and 174 children matched to those in the cerebral-edema group with respect to age at presentation, onset of diabetes

11. Brain Edema And Cerebral Edema, March 2, 2004 Brain Edema and cerebral edema. cerebral edema is an increase in brain volumecaused by an absolute increase in cerebral tissue water content. http://www.medical-library.org/journals2a/brain_edema.htm

Click here to view next page of this article Brain Edema and Cerebral Edema Cerebral edema is an increase in brain volume caused by an absolute increase in cerebral tissue water content. Diffuse cerebral edema may develop soon after head injury. Vasogenic edema arises from transvascular leakage caused by mechanical failure of the tight endothelial junctions of the BBB. Vasogenic edema is frequently associated with focal contusions or hematomas. It eventually resolves as edema fluid is reabsorbed into the vascular space or the brain edema and cerebral edema. Cytotoxic edema is an intracellular process that results from membrane pump failure. It is very common after head injury and is frequently associated with posttraumatic ischemia and tissue hypoxia. Normal membrane pump activity depends on adequate CBF to ensure adequate substrate and oxygen delivery. Alteration in Consciousness Consciousness is a state of awareness of the self and of the environment and requires intact functioning of the cerebral cortices and the reticular activating system (RAS) of the brain stem. Herniation Cerebral herniation occurs when increasing cranial volume and ICP overwhelms the natural compensatory capacities of the CNS. Increased ICP may be the result of posttraumatic brain swelling, edema formation.

12. CNS Pathology The surface of the brain with cerebral edema demonstrates widened gyri with a flattened surface. The sulci are narrowed. http://www-medlib.med.utah.edu/WebPath/CNSHTML/CNS056.html

The surface of the brain with cerebral edema demonstrates widened gyri with a flattened surface. The sulci are narrowed.

13. Introduction: High Altitude Cerebral Edema - WrongDiagnosis.com Introduction to High altitude cerebral edema as a medical condition includingsymptoms, diagnosis, misdiagnosis, treatment, prevention, and prognosis. http://www.wrongdiagnosis.com/h/high_altitude_cerebral_edema/intro.htm

Diseases IMPORTANT! Use of this site is subject to our and Home Symptoms Diseases Risks Search: We show you all these ads in order to provide this free site; give your feedback WrongDiagnosis TM Premium Report: Diabetes Diagnosis and Misdiagnosis Available Now! Condition Lists By Organ By Symptom By Class By Prevalence ... List A-Z Current chapter: High altitude cerebral edema Next sections Basic Summary for High altitude cerebral edema Symptoms of High altitude cerebral edema Complications of High altitude cerebral edema Next chapters: Opportunistic infections Nosocomial infections Chemical pneumonia Pneumocystis carinii pneumonia ... Feedback Introduction: High altitude cerebral edema High altitude cerebral edema: Brain condition related to high altitude. Contents for High altitude cerebral edema: Basic Summary for High altitude cerebral edema Symptoms of High altitude cerebral edema Complications of High altitude cerebral edema Diseases Did we miss something? Please tell your story or provide feedback or suggestions By using this site you agree to our and . Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our

14. BioMed Central | Full Text | Hypertonic Saline For Cerebral Edema home journals AZ journals by subject advanced search authors reviewers libraries jobs about my BioMed Central. To obtain access to Current Neurology and Neuroscience Reports through your institution use the options below. http://www.biomedcentral.com/1528-4042/3/524

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15. High Altitude Cerebral Edema HIGH ALTITUDE cerebral edema (HACE). HACE is the result of swellingor brain tissue from fluid leakage. Symptoms can include headache http://www.triplecitizen.com/Kili/hace.htm

HIGH ALTITUDE CEREBRAL EDEMA (HACE) HACE is the result of swelling or brain tissue from fluid leakage. Symptoms can include headache, loss of coordination, weakness, decreasing levels of consciousness including disorientation, loss of memory, hallucinations, psychotic behavior, and coma. Severe instances can lead to death if not treated quickly. Immediate descent is a necessary life-saving measure (2,000 - 4,000 feet). INFORMATION ON ALTITUDE SICKNESS What is High Altitude? Acute Mountain Sickness High Altitude Pulmonary Edema (HAPE) High Altitude Cerebral Edema (HACE) JENNIFER'S JOURNAL Getting there Entering Kilimanjaro National Park Mandara Hut to Horombo Hut 2nd Day at Horombo Hut ... jennifer home ©2001 Jennifer Thompson

16. American Diabetes Association 62nd Annual Meeting And Scientific Sessions Causes of cerebral edema. cerebral edema is a rare but serious complication of diabetic four decades of research into cerebral edema, its underlying pathophysiologic mechanisms have http://www.diabeteshighlights.org/summary/summary.asp?sid=1&stid=5&ld=20

17. NEJM -- Risk Factors For Cerebral Edema In Children With Diabetic Ketoacidosis Original Article from The New England Journal of Medicine Risk Factorsfor cerebral edema in Children with Diabetic Ketoacidosis. http://content.nejm.org/cgi/content/abstract/344/4/264

HOME SEARCH CURRENT ISSUE PAST ISSUES ... HELP Please sign in for full text and personal services Previous Volume 344:264-269 January 25, 2001 Number 4 Next Risk Factors for Cerebral Edema in Children with Diabetic Ketoacidosis Nicole Glaser, M.D., Peter Barnett, M.B., B.S., Ian McCaslin, M.D., David Nelson, M.D., Jennifer Trainor, M.D., Jeffrey Louie, M.D., Francine Kaufman, M.D., Kimberly Quayle, M.D., Mark Roback, M.D., Richard Malley, M.D., Nathan Kuppermann, M.D., M.P.H., for The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics Full Text PDF Editorial by Dunger, D. B. ... Chapters at Harrison's ABSTRACT Background Cerebral edema is an uncommon but devastating complication of diabetic ketoacidosis in children. Risk factors for this complication have not been clearly defined. Methods In this multicenter study, we identified 61 children who had been hospitalized for diabetic ketoacidosis within a 15-year period and in whom cerebral edema had developed. Two additional groups of children with diabetic ketoacidosis but without cerebral edema were also identified: 181 randomly selected children and 174 children matched to those in the cerebral-edema group with respect to age at presentation, onset of diabetes

18. CEREBRAL EDEMA, INCREASED INTRACRANIAL PRESSURE cerebral edema, INCREASED INTRACRANIAL PRESSURE Acetazolamide. Diamox. Tabs 125 and 250 mg; Sequels, sustained release, 500 mg. For acute mountain sickness 250 mg q8h, for pseudotumor cerebri 250750 http://www.neuro.wustl.edu/neuromedical_treatment/edema.html

CEREBRAL EDEMA, INCREASED INTRACRANIAL PRESSURE Acetazolamide Diamox. Tabs 125 and 250 mg; Sequels, sustained release, 500 mg. For acute mountain sickness 250 mg q8h, for pseudotumor cerebri 250-750 mg q8h. Dexamethasone Decadron. Tabs 0.25, 0.5, 0.75, 1.5, 4 and 6 mg. Edema associated with neoplasms and encephalitides and in pseudotumor cerebri. Not shown to be of benefit in trauma and infarction edema. 16 mg/24 hrs, divided doses, PO or IV; may be required in doses as high as 100 mg/24hrs. An immediate loading dose of 10 mg IV may be administered in situations considered urgent. When used for several days or longer should be discontinued with gradually smaller doses. Glycerol May be used in the management of acute infarction edema or for many weeks in the management of chronic cerebral edema as in pseudotumor cerebri or brain tumors for which surgery is no longer appropriate. Oral or by nasogastric tube. 1.5-2.5 g/kg/24 hrs, divided doses, 50% solution in 0.9% saline with lemon or orange juice. 1) Meyer,J.S, Churney,J.Z. et al.Treatment with glycerol of cerebral oedema due to acute cerebral infarction. Lancet 2:993-997,1971.

19. NEJM -- Sign In Correspondence from The New England Journal of Medicine Risk Factorsfor cerebral edema in Children with Diabetic Ketoacidosis. http://content.nejm.org/cgi/content/full/344/20/1556

HOME SEARCH CURRENT ISSUE PAST ISSUES ... HELP Access to this article requires sign-in. Subscribers have access to all content. Other registered users have access to research articles six months old and older. If you're a registered user or an activated subscriber SIGN IN User Name Password Forgot your Password? Click here and we'll e-mail it to you. If you do not use cookies, sign in here. Remember my User Name and Password. PURCHASE THIS ARTICLE Purchase a single article and get immediate online access for just $10. If you're a subscriber but have not yet activated your full online access If you'd like to purchase a subscription to NEJM If you're not a subscriber and want FREE limited access... ACTIVATE YOUR SUBSCRIPTION Subscribers to NEJM are entitled to full access to all online content and features, including 20 FREE online CME exams. OR Receive full access to ALL current content and online features including Personal Archives, PDF article downloads, PDA access, E-mail alerts and 20 FREE online CME exams. OR Receive FREE online access to NEJM Original and Special Articles 6 months after publication and choose to receive the Table of Contents and notification of early release articles via e-mail.

20. Cerebral Edema / Swelling Of The Brain Lawsuit Overview - Find Trial Lawyers And cerebral edema / Swelling of the Brain Overview cerebral edema / Swelling ofthe Brain Overview - Find Trial Lawyers and Attorneys with Experience in http://www.injuryboard.com/view.cfm/Topic=591

June 2, 2004 An estimated 300,000 workplace injuries occur each year in the United States. Vioxx / Rofecoxib Tractor-Trailer Accidents Serzone / Nefazodone Hydrochloride Tort Reform ... Injuries Cerebral Edema / Swelling of the Brain: Overview If you or a family member has been injured, contact a personal injury attorney today. Just fill out InjuryBoard.com's on-line questionnaire and have a personal injury lawyer review your potential personal injury claim - free of charge. Ask an Attorney Swelling of the brain, or cerebral edema, occurs when fluid accumulates in the brain. Would you like to use this material on your law firm web site? What do I do Now? As with many personal injury claims, time is critical. Contact an attorney today to protect your rights. An Injuryboard sponsor will: Help you with the merits of your case. Inform you of your legal rights. Learn more about sponsoring firms There is no charge for this service Yes, I would like to consult with an attorney now.

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