Oedema, Cerebral
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition
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Brain oedema due to tumours and inflammation
Brain oedema due to traumatic injury
DESCRIPTION
- Swelling of brain parenchymal tissue, due to vasogenic, cytotoxic and osmotic causes.
- Only the vasogenic causes, such as brain tumours and inflammation, respond to corticosteroids.
BRAIN OEDEMA DUE TO TUMOURS AND INFLAMMATION
G93.6
GENERAL MEASURES
- Supportive management. See Stroke.
- Treat the underlying cause. This is especially important where brain oedema is associated with systemic conditions, such as electrolyte disturbances and organ failure.
- Patients with primary brain tumours or brain metastases should be considered for definitive treatment of the tumour, which includes surgery and/or radiotherapy.
MEDICINE TREATMENT
- Dexamethasone, IV, 4 mg 6 hourly, initially.
OR
- Betamethasone, oral/IV, 4 mg 6 hourly.
- Discontinue if no response has occurred after 48 hours. o Taper dose according to response and duration of therapy.
BRAIN OEDEMA DUE TO TRAUMATIC INJURY
S06.10-11 + External Cause Code (V,W,X,Y)
GENERAL MEASURES
- Refer patient for neurosurgical opinion, if indicated.
- Supportive management. See Stroke.
Note
DVT prophylaxis with heparin may be contraindicated owing to risk of increased bleeding.
The following measures should be used in patients with raised intracranial pressure:
- head elevation and position,
- airway and ventilation control,
- sedation and analgesia,
- control of fever,
- control of hypertension, and
- prevention of seizures.
Currently, no evidence supports the use of hyperventilation in this setting.
MEDICINE TREATMENT
For raised intracranial pressure, pending a definitive neurosurgical procedure only:
- Mannitol 15–25%, IV, 0.25–1 g/kg administered over 30–60 minutes.
- Monitor neurological response and urine output.
- Beware of hypovolaemia and electrolyte disturbances, especially hypokalaemia.
Note
Corticosteroids should not be used in this setting as they have a harmful effect.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-4_Version 2.0_6 June 2025
Chapter 14 Neurological Disorders_14.14 Oedema, Cerebral