Combined cerebral edema

Combined cerebral edema is a type of cerebral edema in which there is a mixed pattern of both cytotoxic and vasogenic cerebral edema.

It is usually associated with severe systemic damage, such as with:

• hypertensive crises
• severe sepsis / severe inflammatory condition
• hypoxic-ischemic encephalopathy
• intoxication / metabolic systemic disease

Radiographic features

The radiographic features are those of both cytotoxic and vasogenic cerebral edema. Hence, both the grey and white matter are affected, with sulci effacement, loss of cortical differentiation and finger-like hypodensities (CT-scan) / hypersignal (T2/FLAIR).

Treatment and prognosis

This finding usually carries a very poor prognosis. Cerebral herniation is almost inevitable unless aggressive treatment of the underlying etiology is quickly initiated.