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Aneurysmal Subarachnoid Hemorrhage Presenting with Neurogenic Pulmonary Edema and Hemoconcentration

Year 2019, Volume: 10 Issue: 2, 36 - 38, 01.04.2019

Hung-lin Hsu Chien-chin Hsu Kuo-tai Chen

https://doi.org/10.33706/jemcr.550849

Abstract

Introduction

Neurogenic pulmonary edema (NPE) is a
life-threatening condition caused by various significant central nervous system
injuries. It is characterized by an abrupt increase in fluids within the
alveoli and interstitium of the lungs. The mechanism underlying NPE remains
unclear. Few pathophysiological causes—including neurocardiac factors,
neurohemodynamic factors, blast theory, and pulmonary venule adrenergic
hypersensitivity—have been proposed

Case
report

We report the case of a patient with NPE
associated with subarachnoid hemorrhage (SAH) and stress-hemoconcentration.
Adrenergic responses have been reported to play a crucial role in both NPE and
stress-hemoconcentration. We believe that SAH induces an adrenergic surge,
which causes a cascade of reactions and leads to both NPE and
stress-hemoconcentration.

Conclusion

Central nervous
system (CNS) injuries
are crucial and common causes of adrenergic stimulation; therefore, any subtle
signs indicating CNS injuries should be carefully
investigated. The distress of NPE may mask the initial symptoms of CNS injuries.
If the patient is intubated and under mechanical ventilation to treat NPE, the
inciting neurological injury may be overlooked and result in a delayed
diagnosis. 

Keywords

subarachnoid hemorrhage neurogenic pulmonary edema hemoconcentration stress

References

  • 1. Baumann A, Audibert G, McDonnell J, Mertes PM. Neurogenic pulmonary edema. Acta Anaesthesiol Scand. 2007; 51: 447-55.
  • 2. Davison DL, Terek M, Chawla LS. Neurogenic pulmonary edema. Critical Care. 2012; 12: 212.
  • 3. Allen MT, Patterson SM. Hemoconcentration and stress: A review of physiological mechanisms and relevance for cardiovascular disease risk. Biol Psychol. 1995; 41: 1-27.
  • 4. Di Battista AP, Rizoli SB, Lejnieks B, Min A, Shiu MY, Peng HT, et al. Sympathoadrenal Activation is Associated with Acute Traumatic Coagulopathy and Endotheliopathy in Isolated Brain Injury. Shock. 2016; 46: 96-103.
  • 5. Choi KS, Kim JM, Ryu JI, Oh YH. Concurrent Ruptured Pseudoaneurysm of the Internal Carotid Artery and Cerebral Infarction as an Initial Manifestation of Polycythemia Vera. J Korean Neurosurg Soc. 2015; 58: 137-40.

Year 2019, Volume: 10 Issue: 2, 36 - 38, 01.04.2019

Hung-lin Hsu Chien-chin Hsu Kuo-tai Chen

https://doi.org/10.33706/jemcr.550849

Abstract

References

  • 1. Baumann A, Audibert G, McDonnell J, Mertes PM. Neurogenic pulmonary edema. Acta Anaesthesiol Scand. 2007; 51: 447-55.
  • 2. Davison DL, Terek M, Chawla LS. Neurogenic pulmonary edema. Critical Care. 2012; 12: 212.
  • 3. Allen MT, Patterson SM. Hemoconcentration and stress: A review of physiological mechanisms and relevance for cardiovascular disease risk. Biol Psychol. 1995; 41: 1-27.
  • 4. Di Battista AP, Rizoli SB, Lejnieks B, Min A, Shiu MY, Peng HT, et al. Sympathoadrenal Activation is Associated with Acute Traumatic Coagulopathy and Endotheliopathy in Isolated Brain Injury. Shock. 2016; 46: 96-103.
  • 5. Choi KS, Kim JM, Ryu JI, Oh YH. Concurrent Ruptured Pseudoaneurysm of the Internal Carotid Artery and Cerebral Infarction as an Initial Manifestation of Polycythemia Vera. J Korean Neurosurg Soc. 2015; 58: 137-40.
There are 5 citations in total.

Details

Primary Language English
Journal Section Case Report
Authors

Hung-lin Hsu This is me

Chien-chin Hsu This is me

Kuo-tai Chen This is me

Publication Date April 1, 2019
Submission Date October 10, 2017
Published in Issue Year 2019 Volume: 10 Issue: 2

Cite

APA Hsu, H.-l., Hsu, C.-c., & Chen, K.-t. (2019). Aneurysmal Subarachnoid Hemorrhage Presenting with Neurogenic Pulmonary Edema and Hemoconcentration. Journal of Emergency Medicine Case Reports, 10(2), 36-38. https://doi.org/10.33706/jemcr.550849
AMA Hsu Hl, Hsu Cc, Chen Kt. Aneurysmal Subarachnoid Hemorrhage Presenting with Neurogenic Pulmonary Edema and Hemoconcentration. Journal of Emergency Medicine Case Reports. April 2019;10(2):36-38. doi:10.33706/jemcr.550849
Chicago Hsu, Hung-lin, Chien-chin Hsu, and Kuo-tai Chen. “Aneurysmal Subarachnoid Hemorrhage Presenting With Neurogenic Pulmonary Edema and Hemoconcentration”. Journal of Emergency Medicine Case Reports 10, no. 2 (April 2019): 36-38. https://doi.org/10.33706/jemcr.550849.
EndNote Hsu H-l, Hsu C-c, Chen K-t (April 1, 2019) Aneurysmal Subarachnoid Hemorrhage Presenting with Neurogenic Pulmonary Edema and Hemoconcentration. Journal of Emergency Medicine Case Reports 10 2 36–38.
IEEE H.-l. Hsu, C.-c. Hsu, and K.-t. Chen, “Aneurysmal Subarachnoid Hemorrhage Presenting with Neurogenic Pulmonary Edema and Hemoconcentration”, Journal of Emergency Medicine Case Reports, vol. 10, no. 2, pp. 36–38, 2019, doi: 10.33706/jemcr.550849.
ISNAD Hsu, Hung-lin et al. “Aneurysmal Subarachnoid Hemorrhage Presenting With Neurogenic Pulmonary Edema and Hemoconcentration”. Journal of Emergency Medicine Case Reports 10/2 (April 2019), 36-38. https://doi.org/10.33706/jemcr.550849.
JAMA Hsu H-l, Hsu C-c, Chen K-t. Aneurysmal Subarachnoid Hemorrhage Presenting with Neurogenic Pulmonary Edema and Hemoconcentration. Journal of Emergency Medicine Case Reports. 2019;10:36–38.
MLA Hsu, Hung-lin et al. “Aneurysmal Subarachnoid Hemorrhage Presenting With Neurogenic Pulmonary Edema and Hemoconcentration”. Journal of Emergency Medicine Case Reports, vol. 10, no. 2, 2019, pp. 36-38, doi:10.33706/jemcr.550849.
Vancouver Hsu H-l, Hsu C-c, Chen K-t. Aneurysmal Subarachnoid Hemorrhage Presenting with Neurogenic Pulmonary Edema and Hemoconcentration. Journal of Emergency Medicine Case Reports. 2019;10(2):36-8.