Diagnosis

Prior to the advent of sophisticated neuroimaging techniques, a precise diagnosis ofcerebral edema relied

Figure 11 Diffuse cerebral edema with swollen gyri and focal cortical contusion (arrow) noted at autopsy. (Courtesy of Harry V. Vinters, M.D.)

on the histopathologic examination of brain tissue by biopsy or at autopsy. Figure 11 illustrates the gross appearance of diffuse cerebral edema noted at autopsy. Although a demonstration of increased par-enchymal water content confirmed the presence of cerebral edema, the underlying pathogenesis was largely obscured by the ultimate changes prior to tissue sampling. The invasive nature of brain biopsy limited the study of the dynamic aspects of cerebral edema. Even the inferential evidence derived from detailed neuroradiographic studies including cerebral angiography and ventriculography demanded an invasive procedure. Radionucleide scanning introduced a diagnostic tool for the demonstration of vasogenic edema of various etiologies. The development of CT further refined the delineation of cerebral edema. Unfortunately, the characteristic CT hypodensity of edematous brain parenchyma may be similar to the appearance of chronic infarction and lipid-containing structures. The introduction of MRI revolutionized the understanding of cerebral edema, allowing for the serial study of dynamic pathophysiologic changes associated with various types of edema. Current diagnostic approaches are based on measures that assess ICP, CT, and advanced MRI techniques when available.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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