Confirmation of brain edema

The diagnosis of cerebral edema is usually made after clinical presentation of symptoms or signs relating to raised ICP. The differential diagnosis will include mass lesions. Diagnosis is usually made by CT or MRI appearance. On CT scanning, edema is characterized by a low-density area with a shift of surrounding tissues due to the dilution of lipid structures with water. CT has limitations in detecting edema in the white matter and tends to underestimate its severity. Edema associated with abscesses is well visualized, but edema after acute cerebral hemorrhage is rarely visible. Abnormal blood-brain barrier characteristics can be demonstrated by timed measurements of contrast or radionuclide uptake, but interpretation depends on the size of the markers. MRI is a very sensitive but less specific imaging technique. It is particularly useful for detecting edema in the white matter. Magnetic resonance relaxation time, mapping, and marker-enhanced imaging can be used to interrogate blood-brain barrier integrity. Extravasation of larger molecules into the surrounding tissue can be visualized using marker substances.

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