This volume is a compilation of papers presented at the Tenth International Symposium on Brain Edema held on October 20-23, 1996, in San Diego, California. This follows the sequence of meetings that was initiated 31 years ago in the First International Symposium held in Vienna. Subsequent symposiums were held in Mainz, Montreal, Berlin, Groningen, Tokyo, Baltimore, Bern, and Tokyo CY okohama). A considerable number of papers was chosen from over 100 papers that were received. The organizers wish to thank the Advisory Committee for the excellent work done in selection of the papers. We also wish to thank all the persons who contributed to the success of the Tenth International Symposium, especially the staff who worked behind the scenes. These papers were reviewed, edited, approved or disapproved by the Editorial Board. Those manuscripts that were felt not pertinent to this publication were not accepted by the Editorial Board. Therefore, the excellent quality of those that are in the book are a reflection of the authors' dedication and work and that of those of the Editorial Board in their review process. For the reader's convenience, the papers are structured according to the various disease processes which are associated with the primary topic: hypertension, hydrocephalus, infection, ischemia, tumor, etc. We do hope that the reader will enjoy the articles and that they will provide an impetus and insight for future work.

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.

Brain edema is found in a wide variety of clinical disorders including stroke, intracerebral haemorrhage, subarachnoid haemorrhage, head injury, brain tumors and hydrocephalus. This volume brings together clinical and basic scientists from all over the world. Their expertise in the understanding of brain edema and shifts in brain water compartments has led to a further significant step in our understanding of those diseases characterized by brain edema. This book has also drawn on the expertise of the International Advisory Board of the Brain Edema Society, who have carefully summarized each section, thus providing an easy-to-read summary of the latest advances in each subject. The book is therefore much more than a collection of papers: it represents a critical appraisal and puts each paper into modern scientific context. The greatest advances have come from the rapid development of modern imaging techniques, especially with magnetic resonance imaging (MRI). Imaging can now produce "water maps” and "metabolic profiles” that bring brain metabolism and water content right into every clinic with access to MRI. This book provides the background knowledge to understand these pathophysiological changes.

More than 60 papers written by internationally recognized experts cover the broad spectrum of brain edema. The main topics treated are: ischemia & hemorrhage, trauma (experimental and clinical), cerebral hemorrhage, tumor, hydrocephlaus & intracranial pressure (ICP), neuromonitoring & neuroimaging, treatments, blood brain barrier, and miscellaneous.

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.

Brain edema is a simple phenomenon – an abnormal increase of brain tissue volume by the increase of brain tissue water content. However the etiology is not simple and relating to a wide variety of neurological disorders including ischemia, trauma, tumor, hemorrhage and hydrocephalus. It is still a major cause of death in the neurological/neurosurgical ward. This volume is an up-to-date report on progress in brain edema research, diagnosis and treatment, including papers presented at the 12th International Symposium on Brain Edema and Brain Tissue Injury in 2002. Major topics include molecular biology and blood-brain barrier disorders, ischemic and traumatic brain edema, imaging and diagnosis of brain edema, treatment and radiation effect. Various papers in the rapidly growing fields of neuroimaging and molecular medicine are also included.

Vols. for 1963- include as pt. 2 of the Jan. issue: Medical subject headings.

The first International Symposium on Brain Edema was organized by Dr. Klatzo and Dr. Seitelberger and held in Vienna in 1965. The second Symposium was held in Mainz in 1972 and organized by Dr. H.J. Reulen and Dr. K. Schiirmann, the third in Montreal in 1976 by Dr. H.M. Pap pius, the fourth in Berlin in 1979 by Dr. J. Cervos-Navarro, and the fifth in Groningen in 1982 by Dr. K.G. Go. This volume contains the papers presented at the 6th International Sym posium on Brain Edema, held in Tokyo, Japan, November 7-10, 1984. The invited lectures by Dr. I. Klatzo, Dr. A. Hirano, Dr. S.I. Rapoport, Dr. B.K. Siesj6, Dr. H.M. Pappi us, Dr. K.A. Hossmann, and Dr. D.M. Long are included as special chapters. On behalf of the organizing committee, I wish to express my deep ap preciation to all the participants for their contribution toward making this meeting so fruitful and significant. Moreover, the great success of this Sym posium depended on the high quality of the invited lectures and presen tations by experts in various fields, as well as on the free and enthusiastic discussion. I was deeply impressed with the papers presented by all the authors, who endeavored to elucidate their subjects. The editors have made only minor corrections and rearrangements, since prompt publi cation was considered to be important.