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In many cases there is evidence of constriction of the blood vessels (if angiography is performed), suggesting a possible overlap with reversible cerebral vasoconstriction syndrome (RCVS). Diffusion MRI may be used to identify areas of cytotoxic edema caused by poor blood flow (ischemia) but it is not clear if this prognostically relevant.
Posterior reversible encephalopathy syndrome has a similar presentation, and is found in 10–38% of RCVS patients. [1] RCVS is diagnosed by detecting diffuse reversible cerebral vasoconstriction. [1] Catheter angiography is ideal, but computed tomography angiography and magnetic resonance angiography can identify about 70% of cases. [1]
Cerebral edema is a potentially life-threatening complication of severely decreased sodium ion concentration in the blood (hyponatremia). [17] Ionic brain edema can also occur around the sites of brain hemorrhages, infarcts, or contusions due to a local plasma osmolality pressure gradient when compared to the high osmolality in the affected tissue.
Hypertensive encephalopathy (HE) is general brain dysfunction due to significantly high blood pressure. [3] Symptoms may include headache, vomiting, trouble with balance, and confusion. [1] Onset is generally sudden. [1] Complications can include seizures, posterior reversible encephalopathy syndrome, and bleeding in the back of the eye. [1] [3]
The body (in particular the brain) adapts to the higher sodium concentration. Rapidly lowering the sodium concentration with free water, once this adaptation has occurred, causes water to flow into brain cells and causes them to swell. This can lead to cerebral edema, potentially resulting in seizures, permanent brain damage, or death.
Clinical signs of cerebral edema, such as focal neurological deficits, papilledema [5] and decreased level of consciousness, if temporally associated with recent hemodialysis, suggest the diagnosis. A computed tomography of the head is typically done to rule-out other intracranial causes.
Lee's death was officially ruled the result of cerebral edema — swelling of the brain. While a normal human brain is about 3 pounds, Lee's was reportedly closer to 3½ pounds.
Vascular dementia can be caused by ischemic or hemorrhagic infarcts affecting multiple brain areas, including the anterior cerebral artery territory, the parietal lobes, or the cingulate gyrus. [5] On rare occasion, infarcts in the hippocampus or thalamus are the cause of dementia. [ 12 ]