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The Effect of Dexamethasone on Water and Electrolyte Content and on rCBF in Perifocal Brain Edema in Man

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Steroids and Brain Edema

Summary

The results of clinical studies are reported dealing with the relationship between cerebral edema and regional cerebral blood flow in patients with brain tumor as well as with the effect of dexamethasone on this relationship. rCBF is found to be significantly reduced in brain tissue surrounding brain tumors. Autoregulation as well as cerebrovascular reactivity to PaCO2 is focally or generally impaired. Water content of perifocal white matter is markedly increased. The combination of tissue lactacidosis, low regional blood flow and vasoparalysis seems to be a characteristic finding in this type of local brain edema. The increased local tissue pressure, due to the increased tissue water content, is a main factor responsible for the local flow decrease. A locally elevated tissue pressure will tend to collapse the capillaries and the venules, raise the local cerebrovascular resistance and counteract the vasodilating effect of a low tissue pH.

Administration of dexamethasone (16 mg or 24 mg daily during 4–6 days) reduces the water and sodium content in edematous white matter surrounding a brain tumor but does not influence the potassium content. Measurements of rCBF before and after dexamethasone treatment (24 mg daily during 5–7 days) discloses a significant increase in mean rCBF. Impaired vasomotor response to changes in arterial PCO2 as well as to changes in arterial blood pressure is markedly improved. The beneficial effect of this drug could be locally demonstrated even in absence of marked signs of increased ICP (case report).

Supported by a grant of the Volkswagen-Foundation.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Mainz, Mainz, W. Germany

    Hans J. Reulen, Alexander Hadjidimos & Kurt Schürmann

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  1. Hans J. Reulen
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  2. Alexander Hadjidimos
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  3. Kurt Schürmann
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  1. Neurochirurgische Universitätsklinik Mainz, 6500, Mainz, Langenbeckstr. 1, W. Germany

    H. J. Reulen  & K. Schürmann  & 

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Reulen, H.J., Hadjidimos, A., Schürmann, K. (1972). The Effect of Dexamethasone on Water and Electrolyte Content and on rCBF in Perifocal Brain Edema in Man. In: Reulen, H.J., Schürmann, K. (eds) Steroids and Brain Edema. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-65448-0_27

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  • DOI: https://doi.org/10.1007/978-3-642-65448-0_27

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  • Print ISBN: 978-3-540-05958-5

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