Aneurysmal Subarachnoid Hemorrhage Presenting with Neurogenic Pulmonary Edema and Hemoconcentration

Öz

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. 

Anahtar Kelimeler

• subarachnoid hemorrhage,neurogenic pulmonary edema,hemoconcentration,stress

Kaynakça

1. 1. Baumann A, Audibert G, McDonnell J, Mertes PM. Neurogenic pulmonary edema. Acta Anaesthesiol Scand. 2007; 51: 447-55.
2. 2. Davison DL, Terek M, Chawla LS. Neurogenic pulmonary edema. Critical Care. 2012; 12: 212.
3. 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. 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. 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.