The cranium has very limited
expansible capacity. Furthermore, the brain has few,
if any, demonstrable functioning lymphatic channels
under ordinary conditions. Thus, the presence of
very small amounts of excess fluid puts into serious
jeopardy the physiologic as well as compensatory
pathophysiologic processes. The junctions between
the capillary endothelial cells and glial surfaces
are tight and closely regulate the to and fro
movement of fluid and solutes between the two
compartments. That is the morphologic underpinning
of the brain-blood barrier (BBB).
Cerebral edema is of three main
types: (1) vasogenic due to changes in permeability;
(2) cytotoxic due to intracellular and extracellular
fluid regulations; and (3) interstitial edema that
is regarded as transudate. All three types occur in
acute oxidative-dysoxygenative lesions associated
with infectious, toxic reactions, metabolic
derangement, and malignant neoplasms.
As in the case of the pathophysiologic roles of
the glia, there are major differences in the
prevailing opinions in neurology and neuropathology
on one hand and integrative medicine on the other.
I believe cerebral edema plays a significant
contributory role in the pathogenesis of many
neurologic symptoms seen in fatigue/fibromyalgia
complex and those associated with allergic
reactions, chemical sensitivity syndrome, and
environmental exposures as well as in hormone
disorders, such as severe PMS, endometriosis, and
others. The concept of brain allergy usually
draws derogatory comments from most neurologists.
Yet, it is a valid concept from a clinical
standpoint since it calls for detox measures and the
use of diuretics to control symptoms.