Rethinking the pathogenesis and management of posttraumatic acute diffuse brain swelling

doi:10.3877/cma.j.issn.2095-9141.2025.06.001

Abstract

Abstract:

Posttraumatic acute diffuse brain swelling (PADBS), as a severe pathological phenomenon of traumatic brain injury, has long faced challenges such as inconsistent diagnostic criteria and suboptimal treatment outcomes. Therefore, breakthrough explorations into the pathogenesis and treatment strategies of PADBS are urgently needed. This article systematically integrates and reviews the concept, pathogenesis, pathogenic factors, and treatment strategies of PADBS by combining domestic and international literature with research progress from our team. The aim of this article is to provide a new theoretical framework and research approach for the clinical management of PADBS patients, laying a theoretical foundation for precise and effective diagnosis and treatment.

Key words: Traumatic brain injury, Posttraumatic acute diffuse brain swelling, Brain edema, "Dual switch" theory, Controlled decompression technique

Shousen Wang, Dan Ye, Long Lin, Shuling Chen, Shilong Fu, Sang Chen, Liang Xian, Yongliang Wang, Yuhai Wang. Rethinking the pathogenesis and management of posttraumatic acute diffuse brain swelling[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2025, 11(06): 341-345.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsjcswkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9141.2025.06.001

https://zhsjcswkdzzz.cma-cmc.com.cn/EN/Y2025/V11/I06/341

References 30

[1]	张春雷,王玉海,蔡学见,等.外伤性急性弥漫性脑肿胀的相关危险因素分析[J].中华神经外科杂志, 2012, 28(1): 66-69. DOI: 10.3760/cma.j.issn.1001-2346.2012.01.022.
[2]	Sivandzade F, Alqahtani F, Cucullo L. Traumatic brain injury and blood-brain barrier (BBB): underlying pathophysiological mechanisms and the influence of cigarette smoking as a premorbid condition[J]. Int J Mol Sci, 2020, 21(8): 2721. DOI: 10.3390/ijms21082721.
[3]	Klatzo I. Presidental address. Neuropathological aspects of brain edema[J]. J Neuropathol Exp Neurol, 1967, 26(1): 1-14. DOI: 10.1097/00005072-196701000-00001.
[4]	张春雷,王玉海,蔡桑,等.外伤性急性弥漫性脑肿胀的临床分型及治疗[J].中华神经外科杂志, 2012, 28(10): 1054-1056. DOI: 10.3760/cma.j.issn.1001-2346.2012.10.024.
[5]	Kashkoush AI, Potter T, Petitt JC, et al. Novel application of the Rotterdam CT score in the prediction of intracranial hypertension following severe traumatic brain injury[J]. J Neurosurg, 2023, 138(4): 1050-1057. DOI: 10.3171/2022.6.Jns212921.
[6]	Fu S, Wu X, Wang G, et al. An interpretable machine learning model for predicting early neurological deterioration following posttraumatic acute diffuse brain swelling[J]. Neurocrit Care, 2025, 43(3): 736-744. DOI: 10.1007/s12028-025-02340-y.
[7]	Fu S, Liu H, Wang G, et al. Incidence, risk factors, and clinical outcomes of acute brain swelling associated with traumatic acute subdural hematoma: a retrospective study utilizing novel diagnostic criteria[J]. Ther Adv Neurol Disord, 2024, 17: 17562864241242944. DOI: 10.1177/17562864241242944.
[8]	傅世龙,鲜亮,王守森.创伤性急性弥漫性脑肿胀的发生机制与诊疗研究进展[J].中华创伤杂志, 2023, 39(3): 283-288. DOI: 10.3760/cma.j.cn501098-20220922-00634.
[9]	Chaves T, Fazekas CL, Horváth K, et al. Stress adaptation and the brainstem with focus on corticotropin-releasing hormone[J]. Int J Mol Sci, 2021, 22(16): 9090. DOI: 10.3390/ijms22169090.
[10]	Wu R, Liu C, Ma T, et al. Analysis of the risk factors for intraoperative acute diffuse brain swelling in patients with isolated traumatic acute subdural haematomas[J]. BMC Surg, 2022, 22(1): 187. DOI: 10.1186/s12893-022-01637-5.
[11]	Sawauchi S, Abe T. The effect of haematoma, brain injury, and secondary insult on brain swelling in traumatic acute subdural haemorrhage[J]. Acta Neurochir (Wien), 2008, 150(6): 531-536; discussion 536. DOI: 10.1007/s00701-007-1497-2.
[12]	Xian L, Wang C, Wei L, et al. Cerebral blood flow disorder in acute subdural hematoma and acute intraoperative brain bulge[J]. Front Neurol, 2022, 13: 815226. DOI: 10.3389/fneur.2022.815226.
[13]	Chen S, Zhang SM, Wang SS. Cortical microbleeds in a 7-year-old child with post-traumatic acute diffuse brain swelling[J]. Asian Journal of Surgery, 2025, 48(6): 3736-3738. DOI: 10.1016/j.asjsur.2024.12.178.
[14]	王守森,鲜亮,林珑,等.血流动力学"双开关":脑外伤患者术中脑膨出的新认识[J].中国微侵袭神经外科杂志, 2023, 27(12): 1-4. DOI: 10.11850/j.issn.1009-122X.2023.12.001.
[15]	Simard JM, Kent TA, Chen M, et al. Brain oedema in focal ischaemia: molecular pathophysiology and theoretical implications[J]. Lancet Neurol, 2007, 6(3): 258-268. DOI: 10.1016/s1474-4422(07)70055-8.
[16]	Huang LQ, Zhu GF, Deng YY, et al. Hypertonic saline alleviates cerebral edema by inhibiting microglia-derived TNF-α and IL-1β-induced Na-K-Cl cotransporter up-regulation[J]. J Neuroinflammation, 2014, 11: 102. DOI: 10.1186/1742-2094-11-102.
[17]	Chen W, Sheng J, Peng G, et al. Early stage alterations of catecholamine and adrenocorticotropic hormone levels in posttraumatic acute diffuse brain swelling[J]. Brain Res Bull, 2017, 130: 47-52. DOI: 10.1016/j.brainresbull.2017.01.003.
[18]	陆宏达,姜素文,吴霄迪,等.神经源性肺水肿6例临床分析及文献复习[J].中华危重病急救医学, 2022, 34(2): 188-190. DOI: 10.3760/cma.j.cn121430-20211230-01956.
[19]	陈卫良,杨理坤,匡红,等.窦汇区球囊加压法制备急性弥漫性脑肿胀动物模型[J].中华创伤杂志, 2015, 31(8): 753-757. DOI: 10.3760/cma.j.issn.1001-8050.2015.08.020.
[20]	Orr TJ, Lesha E, Kramer AH, et al. Traumatic brain injury: a comprehensive review of biomechanics and molecular pathophysiology[J]. World Neurosurg, 2024, 185: 74-88. DOI: 10.1016/j.wneu.2024.01.084.
[21]	Corps KN, Roth TL, McGavern DB. Inflammation and neuroprotection in traumatic brain injury[J]. JAMA Neurol, 2015, 72(3): 355-362. DOI: 10.1001/jamaneurol.2014.3558.
[22]	Mao M, Xu Y, Zhang XY, et al. MicroRNA-195 prevents hippocampal microglial/macrophage polarization towards the M1 phenotype induced by chronic brain hypoperfusion through regulating CX3CL1/CX3CR1 signaling[J]. J Neuroinflammation, 2020, 17(1): 244. DOI: 10.1186/s12974-020-01919-w.
[23]	Cash A, Theus MH. Mechanisms of blood-brain barrier dysfunction in traumatic brain injury[J]. Int J Mol Sci, 2020, 21(9): 3344. DOI: 10.3390/ijms21093344.
[24]	Lingsma HF, Roozenbeek B, Perel P, et al. Between-centre differences and treatment effects in randomized controlled trials:a case study in traumatic brain injury[J]. Trials, 2011, 12: 201. DOI: 10.1186/1745-6215-12-201.
[25]	Carney N, Totten AM, O'Reilly C, et al. Guidelines for the management of severe traumatic brain injury, fourth edition[J]. Neurosurgery, 2017, 80(1): 6-15. DOI: 10.1227/neu.0000000000001432.
[26]	Roberts I. Barbiturates for acute traumatic brain injury[J]. Cochrane Database Syst Rev, 2000, 2: CD000033. DOI: 10.1002/14651858.CD000033.
[27]	Hui H, Rao W, Zhang L, et al. Inhibition of Na(+)-K(+)-2Cl(-) Cotransporter-1 attenuates traumatic brain injury-induced neuronal apoptosis via regulation of Erk signaling[J]. Neurochem Int, 2016, 94: 23-31. DOI: 10.1016/j.neuint.2016.02.002.
[28]	Jha RM, Kochanek PM, Simard JM. Pathophysiology and treatment of cerebral edema in traumatic brain injury[J]. Neuropharmacology, 2019, 145(Pt B): 230-246. DOI: 10.1016/j.neuropharm.2018.08.004.
[29]	Chen K, Dong J, Xia T, et al. Changes in cerebral hemodynamics in patients with posttraumatic diffuse brain swelling after external intraventricular drainage[J]. Chin J Traumatol, 2015, 18(2): 90-94. DOI: 10.1016/j.cjtee.2015.04.001.
[30]	Shi Y, Qian X, Chen T, et al. Controlled decompression improves long-term neurologic function by enhancing early postoperative cerebral microcirculation in patients with severe traumatic brain injury[J]. Surgery, 2025, 187: 109636. DOI: 10.1016/j.surg.2025.109636.

Please choose a citation manager

Content to export