Tom 15, Nr 3 (2019)
Artykuł przeglądowy
Opublikowany online: 2019-10-22
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Obrzęk mózgu u chorych po urazach czaszkowo-mózgowych
Pol. Przegl. Neurol 2019;15(3):151-160.
Streszczenie
Pourazowy obrzęk mózgu jest jedną z najczęstszych przyczyn wzmożonego ciśnienia śródczaszkowego oraz wtórnego niedokrwienia mózgu u chorych po ciężkim urazie czaszkowo-mózgowym (TBI, traumatic brain injury). Wyróżnia się obrzęk cytotoksyczny, czyli dotyczący komórek, i naczyniopochodny, będący następstwem zaburzeń w przepuszczalności bariery krew–mózg (BBB, blood–brain barrier), w wyniku których woda gromadzi się w przestrzeni pozakomórkowej. Czynnościowo i anatomiczne zmiany w BBB spowodowane niedokrwieniem dzieli się na trzy etapy: jonowy, obrzęk naczynioruchowy i tak zwaną konwersję krwotoczną (prowadzącą do powstania ogniska krwotocznego, często występującą w letalnym TBI). Szybkie wdrożenie leczenia przeciwobrzękowego po urazie czaszkowo-mózgowym ma zasadnicze znaczenie dla rokowania, zwiększając szanse przeżycia chorych.
Słowa kluczowe: pourazowy obrzęk mózguuraz czaszkowo-mózgowyleczenie przeciwobrzękoweciśnienie śródczaszkowewtórne niedokrwienie mózgu
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