Pediatric emergency medicine trisk 4022 4022

Brain Edema. Edema often accompanies neoplastic lesions and is more
commonly associated with metastatic tumors. On CT scan, brain edema
appears as an area of decreased density associated with brain shift. Brain
edema is commonly associated with ICH and contusion. Edema associated
with cerebral infarction generally indicates a severe stroke and may lead to
herniation. The treatment of brain edema depends on the cause of the
lesion. Edema (vasogenic edema) caused by neoplasia or inflammation
respond to treatment with steroids. The role of steroids in treating edema
caused by trauma, infarction, or anoxia is unproven. Brain edema (cytotoxic
edema) that occurs after surgery for trauma, infarction, or hemorrhage
represents increased tissue water and may require hyperosmolar therapy as
described above.
Pneumocephalus. Pneumocephalus is simply the accumulation of air in
the intracranial spaces. It commonly occurs after craniotomy if the air is not
completely evacuated before the bone flap is replaced. It may also occur
after a traumatic basilar skull fracture when air is introduced into the
subarachnoid space by communication with the exterior environment,
usually through the ethmoid, sphenoid, or frontal sinuses. A CT scan may
show the accumulation of air beneath a bone flap or in communication with
one of the sinuses. Most cases of pneumocephalus are treated with 100%
oxygen by a nonrebreather mask. Tension pneumocephalus marked by an
enlarging pocket of air causing mass effect (midline shift, sulcal
effacement, or both) demands more aggressive and invasive intervention.
Emergency surgery is necessary to resolve the mass effect.
Pneumocephalus can be an indication of CSF leakage. Although
pneumocephalus indicates a tear in the dura, a CSF leak indicates a
relatively large dural tear allowing a stream of CSF to flow. CSF may drain
through the ethmoid or sphenoid sinus complex, causing rhinorrhea;
through the mastoid air cells, causing otorrhea; or from the scalp suture
line. When rhinorrhea or otorrhea occur postoperatively, they should be
treated conservatively with a lumbar drain. If a seal is not accomplished

after 10 to 14 days of conservative treatment, surgical intervention is
necessary. The use of antibiotics to treat either pneumocephalus or
pneumocephalus with subsequent CSF leak is controversial. Treatment with
antibiotics should not be initiated unless signs and symptoms of CSF
infection develop.