Aneurysmal Subarachnoid Hemorrhage Presenting with Neurogenic Pulmonary Edema and Hemoconcentration

Yıl 2019, Cilt: 10 Sayı: 2, 36 - 38, 01.04.2019

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

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

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. 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.