Cytotoxic edema

Normal and glial homeostasis is maintained by energy-dependent ion pumps in the cell membrane which remove sodium from the inside of cells and concentrate potassium intracellularly. Any situation that interferes with the energy processes, either by lack of substrates and oxygen or by toxicity, will lead to failure of these pump mechanisms. Water and sodium influx into the cell leads to intracellular cytotoxic edema. Reduced cerebral perfusion pressure, vascular distortion or spasm, and vascular obstruction may give rise to ischemic cytotoxic edema if cerebral blood flow falls below 20 ml/100 g/min. Reduction of cerebral blood flow below 18 ml/100 g/min is associated with the release of excitatory amino acids. At this stage the situation is potentially reversible by adequate reperfusion. Further reduction in cerebral blood flow to around 10 ml/100 g/min leads to failure of the potassium and calcium membrane pumps and irreversible damage. Therefore development of ischemic edema depends on both the severity and the duration of reduction of cerebral blood flow and may be global or regional depending on the underlying pathology.

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