Brain Edema Ix

The first international symposium on brain edema was held in Vienna/ Austria in 1965 followed by altogether eight meetings since. The most recent was organized in Y okohama by the Department of Neurosurgery of the Musashino Red Cross Hospital, Tokyo. The continuing interest of both, clinicians and experimental scientists alike may be attributable to the fact that brain edema is a common denominator of many cerebral disorders, which under acute conditions threatens life and weIl-being of afflicted patients. Although progress in understanding as weIl as treatment can be recognized since 1965 many problems remain, particularly concerning the control of brain edema under acute conditions, as in trauma or ischemia. A quantum leap was the distinction of the cytotoxic and vasogenic brain edema prototypes as advanced by Igor Klatzo, providing for transition from a morphological to functional understanding now. The recent brain edema meetings were certainly benefiting from developments of both, molecular neurobiology on the one hand side and functional brain imaging at an ever-increasing resolution on the other, such as magnetic resonance imaging orpositron emission tomography. The international symposium in San Diego 1996 may witness further breakthroughs, hopefully also of effective treatment modalities. The symposium in Y okohama was dedicated to the "Legacy of 28 Years of Brain Edema Research" as a reminder of accomplishments as weIl as remaining challenges.

A workshop on Dynamic Aspects of Cerebral Edema was organized to pro vide an opport~nitY,for interdisciplinary and detailed consideration of this subject, so crucial in neurology and neurosurgery. The previ ous workshops were held in Vienna in 1965 and in Mainz in 1972. In the meantime, our ideas on mechanisms of resolution of cerebral edema had been changing drastically. Controversy had arisen regarding the role of biogenic amines in the development of edema. Active work in several centers had indicated the possibility of a reversible compo nent in edematous changes associated with ischemia, the control of which could be of therapeutic significance in the problem of stroke. It was felt that a thorough discussion, at this time, by those involv ed in these various studies should help to resolve the controversies, to crystallize the implications of the new findings, and to evaluate their application for patient care. In preparing the proceedings for publication we have edited the manu scripts and selected the discussions with an aim to highlight new find ings, to make this volume readable, and to eliminate duplication. We gratefully acknowledge financial support from the institutions and organizations previously listed. Many individuals contributed to the success of the workshop and the preparation of the proceedings for publication. Doctors J.B. Brierley, I. Klatzo, H.J. Reulen, and A.G.

The Symposium on Brain Edema has been organized by the Osterreichische Arbeitsgemeinschaft fur Neuropathologie and by the Problem Commission for Neuropathology of the World Federa tion of Neurology. We would like to express our thanks to Dr. L. van Bogaert, president of the W.F.N., for his great interest in the design of this conference and for his energetic support. One of the aims ofthe Problem Commission for Neuropathology has been to contribute to the advances in various problems which are becoming ripe for elucidation by experts in different fields. The idea of the Symposium on Brain Edema has as its background a compelling necessity to elucidate this subject which is clinically so important and neuropathologic ally so poorly understood. It was hoped that this could be achieved by a multidisciplinary approach involving a variety of aspects to be discussed and correlated. Brain edema, being an abnormal cerebral condition, belongs basically to the sphere of neuropathology, but to be successful in our endeavors we had to apply neuropathology in its most modern and widest terms. By this we understand that such neuropathology includes the study of all abnormal phenomena in the nervous tissue related to the structural alterations, and by "structural" we mean not only tissual or cellular ones but also changes on ultrastructural and molecular levels. Thus we needed close and integrated coopera tion of experts in fields such as neurohistology, histochemistry, electron microscopy, neurochemistry, and neurophysiology.

In this book, leading world authorities on brain edema and neurological disorders/injuries and experts in preconditioning join forces to discuss the latest progress in basic sciences, translational research, and clinical management strategies relating to these conditions. The range of topics covered is wide, including microglia, energy metabolism, trace metals and ion channels, vascular biology, cellular treatment, hemorrhagic stroke, novel technological advances, anesthesia and medical gases, pediatric brain edema, neuroimaging, behavioral assessment, clinical trials, peripheral to central signaling pathways, preconditioning translation, and animal models for preconditioning and brain edema research. The book comprises presentations from Brain Edema 2014, the joint meeting of the 16th International Conference on Brain Edema and Cellular Injury and the 3rd Symposium on Preconditioning for Neurological Disorders, held in Los Angeles on September 27–30, 2014.

This issue contains the proceedings of the most recent Inter national Symposium on Brain Edema, the 5th in a series of confer ences starting 1965 in Vienna. The ever since increasing interest in this field may not only result from the fact that - in clinical terms - the problem is not solved yet, but also from the many fascinating physiological and biochemical questions remaining. Moreover, the rapid progress of technical, physiological and bio chemical developments provides a permanent challenge to probe the subject with better and better resolution. The current proceedings provide many examples. It is safe to assume, that the history of brain edema research is familiar to most of its participants. Therefore, suffice it to remark that since the first histopathological recognition of brain edema as a separate entity among the multitude of intracranial space occupying lesions, progress in the understanding of its pathogenesis has not been straightforward. On the contrary, it has been complicated by confusing notions and concepts, some of which may have resulted from the elusiveness of the edematous changes in early histological studies, due to the inadequacy of the light microscope. Although brain edema occurs concomitantly in many pgtho10gica1 conditions of the brain, it has been suggested that its role is collateral only. Nevertheless, the potential of brain edema as a space occupying lesion is not trivial, since it raises intracranial pressure and eventually may result in lethal cerebral herniation.