Hyperosmolar therapy: A century of treating cerebral edema

Clin Neurol Neurosurg. 2021 Jul;206:106704. doi: 10.1016/j.clineuro.2021.106704. Epub 2021 May 20.


Hyperosmolar therapy is a cornerstone for the management of elevated intracranial pressure in patients with devastating neurological injuries. Its discovery and use in various pathologies has become a valuable therapy in modern neurological critical care across the globe. Although hyperosmolar therapy is used routinely, the history of its origin is still elusive to many physicians. Understanding the basis of discovery and use of different hyperosmolar agents lends insight into the complex management of elevated intracranial pressure. There are very few practices in medicine which has stood the test of time. The discovery of hyperosmolar therapy has not only provided us a wealth of data for the management of intracranial hypertension but has also allowed us to develop new treatment strategies by improving our understanding of the molecular mechanisms of cerebral inflammation, blood-brain permeability, and cerebral edema in all modes of neuronal injury.

Keywords: Cerebral edema; Historical review; Hyper osmolar therapy; Raised intracranial pressure.

Publication types

  • Historical Article
  • Review

MeSH terms

  • Animals
  • Brain Edema / therapy*
  • Diuretics, Osmotic / therapeutic use*
  • History, 18th Century
  • History, 19th Century
  • History, 20th Century
  • Humans
  • Mannitol / therapeutic use*
  • Neurology / history*
  • Neurology / methods
  • Saline Solution, Hypertonic / therapeutic use*


  • Diuretics, Osmotic
  • Saline Solution, Hypertonic
  • Mannitol