Summary
1. New biochemical results have shown that — in accordance with electron microscopical investigations — the edema of the cerebral cortex is completely different from the edema of the white substance, because of its intracellular localization.
The development of the intracellular edema in the brain cortex is caused by a disturbance of the intra- extracellular ionic distribution, whereas the extracellular edema of the white matter is produced by ultrafiltration into the interstitial space.
2. During the phase of edema accummulation in the brain there is a renal retention of water and sodium which depends of the degree of increase in intracranial pressure. Further, there are data indicating thet there is an increase in tubular aldosterone activity. It is difficult to decide whether an increased aldosterone activity has any pathophysiological relevance, since on the one hand Spironolactone — an aldosterone antagonist — causes an improvement in several forms of brain edema, and on the other hand brain edema is often a consequence of the insufficiency of the adrenals as well as of experimental adrenalectomy — whith can be reversed by application of aldosterone.
3. The effect of ethacrynic acid and spironolactone on the edematous brain tissue of two groups of 5 patients has been observed. The tissue had to be removed as a consequence of neurological operations. In contrast to a untreated group of patients, those treated with ethacrynic acid (75 mg/die) 4 days before surgery revealed a significant decrease of the pathological and water and sodium retention in the cortex and white matter. The urinary volume and the renal sodium excretion increased during treatment with this saluretic. After a 4-day treatment with spironolactone (600 mg/die) the edema in the cortex and the white matter was also reduced, and the renal sodium and water excretion could be increased.
These results make further clinical investigations in a larger group of patients desirable.
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Reulen, H.J., Samii, M., Koczorek, K.R., Baethmann, A., Schürmann, K. (1969). Diuretics in Cerebral Edema. In: Thurau, K., Jahrmärker, H. (eds) Renal Transport and Diuretics / Renaler Transport und Diuretica. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-88089-6_46
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