Abstract：
Cerebral Edema (CE) is the final common pathway of brain death. In severe neurological disease, neuronal cell damage first contributes to tissue edema, and then Increased Intracranial Pressure (ICP) occurs, which results in diminishing cerebral perfusion pressure. In turn, anoxic brain injury brought on by decreased cerebral perfusion pressure eventually results in neuronal cell impairment, creating a vicious cycle. Traditionally, CE is understood to be tightly linked to elevated ICP, which ultimately generates cerebral hernia and is therefore regarded as a risk factor for mortality. Intracranial hypertension and brain edema are two serious neurological disorders that are commonly treated with mannitol. However, mannitol usage should be monitored since inappropriate utilization of the substance could conversely have negative effects on CE patients. CE is thought to be related to bloodbrain barrier dysfunction. Nonetheless, a fluid clearance mechanism called the glial-lymphatic or glymphatic system was updated. This pathway facilitates the transport of cerebrospinal fluid (CSF) into the brain along arterial perivascular spaces and later into the brain interstitium. After removing solutes from the neuropil into meningeal and cervical lymphatic drainage arteries, the route then directs flows into the venous perivascular and perineuronal regions. Remarkably, the dual function of the glymphatic system was observed to protect the brain from further exacerbated damage. From our point of view, future studies ought to concentrate on the management of CE based on numerous targets of the updated glymphatic system. Further clinical trials are encouraged to apply these agents to the clinic as soon as possible.
摘要：
脑水肿（CE）是脑死亡的最终共同途径。在严重的神经系统疾病中，神经元细胞损伤首先导致组织水肿，然后颅内压（ICP）升高，导致脑灌注压下降。反过来,由脑灌注压降低引起的缺氧脑损伤最终导致神经元细胞受损，造成恶性循环。传统上,CE被认为与ICP升高密切相关，最终会产生脑疝，因此被认为是死亡的危险因素。颅内高压和脑水肿是两种严重的神经系统疾病，通常用甘露醇治疗。然而,应监测甘露醇的使用情况,因为该物质的不当使用可能反过来对CE患者产生负面影响.认为CE与血脑屏障功能障碍有关。尽管如此，更新了一种称为神经胶质-淋巴系统或淋巴系统的液体清除机制。该途径促进脑脊液（CSF）沿动脉血管周围间隙运输到大脑中，然后进入脑间质。从神经纤维中去除溶质进入脑膜和颈淋巴引流动脉后，然后，该路径将流量引导到静脉血管周围和神经周区域。值得注意的是,观察到淋巴系统的双重功能可以保护大脑免受进一步加剧的损害。从我们的角度来看,未来的研究应该集中在基于更新的淋巴系统的众多目标的CE管理上。鼓励进一步的临床试验，以尽快将这些药物应用于临床。
