Management of Cerebral Edema/Intracranial Pressure in Ischemic Stroke

Ischemic stroke causes cerebral injury that can result in significant cerebral edema. Elevated intracranial pressure (ICP) can result from and is associated with shifts in cerebral architecture due to the development of focal edema causing compression of adjacent structures. Ischemia-associated brain swelling can result in neurological deficits such as depressed consciousness, cranial nerve palsies, respiratory failure, and motor deficits. Medical management can reduce cerebral edema and can often prevent clinical worsening. Surgical decompression, when performed before the occurrence of devastating neurological deficits in select patients, may be beneficial in terms of morbidity and mortality. ICP monitoring and cerebrospinal fluid diversion are not routinely recommended because of the insufficient evidence of their benefits and inherent risks. Recent advances in interventional stroke treatment can often prevent a patient from developing a malignant stroke syndrome secondary to cerebral edema.