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What Are the Treatments for Brain Swelling?

author image Matthew Fox, MD
Dr. Matthew Fox graduated from the University of California with a Bachelor of Arts in molecular, cell and developmental biology and received a M.D. from the University of Virginia. He is a pathologist and has experience in internal medicine and cancer research.
What Are the Treatments for Brain Swelling?
Brain swelling increases the pressure in the skull, which can displace the brain and cause death.

Brain swelling, known in medical terminology as cerebral edema, is a manifestation of various brain injuries such as cancer or trauma, and is dangerous because it raises the pressure inside the skull. The skull is a thick chamber that is not compliant, which means it does not stretch. The danger from increased intracranial pressure comes from the fact that it will actually compress the brain and can push the brain stem out of the bottom of the skull, causing death. Various methods of treatment exist to address cerebral edema.

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According to an article in Neurosurgery Focus, proper positioning is important in persons with cerebral edema. Generally the head is elevated so that the body is 30 degrees to the floor. An exception is with certain stroke patients in whom reducing blood flow into the brain could exacerbate the stroke. In addition, the neck should be positioned so that the jugular veins, the main veins draining the head, are not compressed. This positioning helps blood and fluid to drain out of the head with the assistance of gravity.

Ventilation and Oxygenation

Since the blood carries fluid into the brain, and also takes up space in the head, it is important to optimize how much enters the skull. Too little would lead to a lack of oxygen, and too much would take up excess space and raise the pressure. The build up of carbon dioxide, a waste product of cellular metabolism, and a lack of oxygen both cause the blood vessels in the head to dilate and raise the pressure in the skull. So, a low carbon dioxide level and high oxygen level are helpful to counter this vascular dilation. A breathing tube and ventilator may be used to regulate the levels of carbon dioxide and oxygen in the blood.


Certain drugs help decrease the fluid in the head and in the body as a whole. Mannitol helps remove fluid from the brain by drawing it into the blood vessels from the tissues, and helping the kidneys to eliminate it through the urine. The drug furosemide is used at times as well, and also helps the kidneys remove fluid. Sedatives such as barbiturates also reduce brain metabolism and blood flow, protecting the brain and decreasing the pressure.


Surgery may be warranted at times as well. Removing a part of the rigid skull helps to relieve the pressure; this is called a decompressive craniotomy. Also if significant cerebrospinal fluid, or CSF, is building up, a shunt, or tubing, can be inserted to drain it.

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