[Mediator substances of brain edema in cerebral ischemia]

Abstract

Brain edema in focal or global cerebral ischemia is associated with formation and release of pathophysiologically active mediator compounds. Therapeutical methods which interfere with mediator compounds under these circumstances might improve specificity of treatment of ischemic brain edema and thereby effectivity. Ischemic brain edema has a vasogenic and cytotoxic component. Extravasation of edema fluid under these conditions can be attributed to ischemic damage of the elements of the blood-brain barrier, the cerebrovascular endothelium. The development of ischemic cell swelling involving nerve- and glial cell processes can not be viewed only as manifestation of cell damage resulting from e.g. energy failure but also as an attempt to maintain or reestablish homeostasis important for cell survival and nerve cell function. The acidosis-induced cell swelling is a case in point. Accumulation of H(+)-ions in the cell causes activation of ion exchange mechanisms to protect or normalize the intracellular pH, respectively. Consequently, Na(+)- and Cl-ions together with water accumulate in the cell as the final process underlying cell swelling. Further, the increased concentrations of glutamate and K(+)-ions found in ischemic brain tissue cause glial cell swelling secondary to an active accumulation of this material together with water in the intracellular compartment in an attempt to normalize the extracellular milieu. A therapeutical inhibition of those mechanisms underlying ischemic cell swelling would prevent reestablishment of the homeostasis and, thereby, enhance secondary tissue damage. A focal brain tissue necrosis, such as an ischemic infarct or traumatic contusion can be utilized to illustrate the pathophysiological significance of the formation and release of mediator compounds of secondary brain damage.(ABSTRACT TRUNCATED AT 250 WORDS)