Cytotoxic edema v/s Vasogenic edema

[danielmd06]

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Good morning all.

I am a PGY-2 Neurology resident with a personal interest in Neuroradiology. I am afraid many of you might think this is an easy question, but I thought I could get a streamlined answer on this forum.

Can one of you gentleman explain how different imaging sequences allow you to compare and contrast vasogenic edema versus cytotoxic edema, when each are actually expected in clinical cases, and...exactly how they differ in terms of physiologic etiology. 😳

Yes, I have looked both up. I am having difficulty getting my mind wrapped around these concepts and thought if one of you guys/gals explained it then it might make more sense to me.

Thanks in advance.

Daniel

 

[danielmd06]

99 views and no answers?

 

[danielmd06]

Closing in on two hundred views and no response?

Can anyone at least suggest a book or review article that would clarify this?

Thanks.

 

[Docxter]

Here's a good introductory review. It's a few years old and doesn't have any of the new stuff, but nicely written.

Schaefer PW, Grant PE, Gonzalez RG. Diffusion-weighted MR imaging of the brain. Radiology. 2000 Nov;217(2):331-45.

 

[danielmd06]

Thanks Docxter!

 

[dilatate]

Just a lowly M2, but here it goes:
Cytotoxic edema is due to cells' inability to maintain a proper osmotic gradient, i.e. ischemia leading to energy debt leading to poorly functioning ion pumps. Cells swell with water due to increased intracellular osmolality and so this entity is referred to as "cellular edema" by some.
Vasogenic edema is basically due to the failure of tight junctions and astrocyte processes to maintain an adequate blood-brain barrier due to some sort of CNS inflammation/injury (this is why it responds to corticosteroids). So the fluid is interstitial.

Now the Rads guys/gals have to tell you how you can see the difference between intracelluar (cellular swelling) and extracelluar edema. FLAIR maybe since you can differentiate CSF (ultrafiltrate) from blood in that sequence?

Hope that helped. That was my first SDN post by the way.