Cerebral Oedema After Ischaemic Stroke: Pathogenesis, Natural History, and Potential Medical Treatments From Bench to Bedside

The development of cerebral oedema after ischaemic stroke is a common and potentially devastating complication associated with increased mortality and disability. Despite this, there currently exists no definitive medical treatment for cerebral oedema, and the efficacy of commonly used agents is unclear. In recent decades there has been a significant amount of research attempting to describe the pathogenesis of cerebral oedema in ischaemic stroke which has begun to lead to the development of new potential treatments. In this review we will aim to, firstly, provide a comprehensive overview of the pathogenesis and natural history of cerebral oedema in ischaemic stroke, including cellular mechanisms, breakdown of the blood-brain barrier, the role of the immune system, and potential effects of reperfusion. We will then summarise the evidence base for currently used treatments for cerebral oedema in ischaemic stroke such as hyperosmolar agents, as well as emerging treatments which are still under investigation. Where available, this review will highlight outcomes of clinical trials for these proposed treatments.