(RSS) Trauma Research Blog
Selected new & juicy research papers, with editorial comment.
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PubMed ID: 19479650
Ultrastruct Pathol. 2009;33(3):102-11
Authors: Castejon OJ
Abstract:In a vascular anomaly showing moderate edema, the extracellular space appeared apparently normal, exhibiting a membrane to membrane space of about 20 nm in width. In congenital hydrocephalus, this space appeared notably enlarged and occupied by an electron transparent, nonproteinaceous interstitial edema fluid, due to abnormal accumulation of cerebrospinal fluid. In brain trauma, the distended extracellular space contained either electron-lucid nonproteinaceous or electron-dense proteinaceous edema fluid. Hemorrhagic foci, fibrinoid material, and non-nervous invading cells, such as macrophages and monocytes, were also found. In brain tumors, the widened extracellular space showed electron-dense proteinaceous edema fluid and bundles of fibrinoid material. The enlarged extracellular space found in congenital hydrocephalus, vascular anomalies, brain trauma, and tumors is closely related to the clinical symptoms exhibited by the patients under study.
Notes & Commentary:
How simplistic our clinical view of traumatic brain injury is. We think only of intracranial pressure, perfusion pressure, and cerebral oxygen delivery & utilization. We understand cerebral oedema only as a hydrostatic effect to be treated with osmotic therapy. This study shows that cerebral oedema in traumatic brain injury is far from a simple fluid shift but is instead a complex phenomenon, probably containing a complex of proinflammatory and coagulant mediators of the innate immune system. We need to rapidly develop a more complex approach to our clinical understanding of these injuries if we are to make any progress in their management - progress which has been relatively disappointing over the past few decades.