Distribution of Fluid in the Brain

The normal water content of the human brain is approximately 80% by weight, with higher amounts of water in the gray matter than in the white matter. Fluid is distributed among the intraluminal cerebrovascula-ture, the intracellular space of the parenchyma, the extracellular space of the interstitium, and the ventricular system. Therefore, a complex interaction of morphologic features and biochemical processes exists to maintain the normal fluid balance of the brain. An increase in the intravascular plasma volume of the cerebral circulation may lead to fluid engorgement of the brain. Although such an increase in cerebral blood volume is not inherently pathologic, an associated alteration of the BBB may cause fluid to extravasate into the extracellular compartment. Increased water content in the interstitial space may result from obstruction of CSF outflow in the ventricular system with resultant transependymal exudation of fluid. Fluid homeostasis within the intracellular compartment may be altered by many factors, thus leading to cellular edema. To define characteristic features of specific forms of cerebral edema, the location of edema fluid accumulation as extracellular, intracellular, or both proves to be a useful tool, as does the predilection for gray or white matter involvement.

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