Boğaziçi Tıp Dergisi

Rohat Ak et al.
BOĞAZİÇİ TIP DERGİSİ; 2017; 4 (1): 35-36
Case Report
Acute Dyspnea After Subarachnoid Hemorrhage:
Is It Neurogenic Pulmonary Edema?
Subaraknoid Kanama Sonrası Akut Dispne: Bu Nörojenik Akciğer Ödemi mi?
Fatih DOĞANAY 1 , Rohat AK 1 , Tevfik PATAN 1
1. University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Emergency Medicine Clinic
ABSTRACT
Neurogenic pulmonary edema (NPE) is a clinical
diagnosis based upon the occurrence of pulmonary
edema in the appropriate setting and in the
absence of a more likely alternative cause. NPE is
defined as an increase in pulmonary interstitial and
alveolar fluid caused by an acute central nervous
system injury. Pulmonary edema in patients with
subarachnoid hemorrhage (SAH) has been associated
with high-grade SAH, increased mortality.
Early infiltrates, which treated effectively, did not
affect mortality, mostly . In this case report, we aimed
to present a patient who developed NPE due to
SAH in the emergency department.
Keywords: neurogenic pulmonary edema; subarachnoid
hemorrhage; dsypnea
INTRODUCTION
Neurogenic pulmonary edema (NPE) is
defined as an increase in pulmonary interstitial
and alveolar fluid caused by an acute central
nervous system injury (1). It has been reported
in patients with subarachnoid hemorrhage
(SAH), traumatic brain injury, intracerebral
hemorrhage, status epilepticus, meningitis, spinal
cord injury, intracranial tumors, ischemic
stroke and multiple sclerosis (2). But still NPE
is underdiagnosed after serebrovascular accidents
although it may course mortally if it is
not treated early. We presented a patient who
developed NPE in emergency department due
to SAH and we revealed the presentation and
diagnosis for ED doctors in this case report.
CASE
ÖZET
Nörojenik pulmoner ödem (NPE), uygun ortamda
pulmoner ödem oluşumuna ve daha olası
bir alternatif neden bulunmadığına dayalı klinik bir
tanıdır. NPE akut merkezi sinir sistemi hasarının
yol açtığı pulmoner interstisyel ve alveoler sıvıda
bir artış olarak tanımlanır. Subaraknoid kanamalı
(SAK) hastalarda pulmoner ödem, yüksek dereceli
SAK ile ilişkili olup mortaliteyi arttırmaktadır. Etkili
bir şekilde tedavi edilen erken infiltratlar çoğunlukla
mortaliteyi etkilemez. Bu olgu sunumunda
acil serviste SAK nedeniyle NPE gelişen bir hastayı
sunmayı amaçladık.
Anahtar Kelimeler: nörojenik pulmoner ödem; subaraknoid
kanama; dispne
Contact
Corresponding Author: Rohat AK
Address: Istanbul Fatih Sultan Mehmet Training and Research Hospital,
Icerenkoy, 34752 Atasehir, Istanbul, Turkiye
Phone Number: +90 (506) 821 31 36
E-mail: rohatakmd@gmail.com
Submitted: 03.01.2017
Accepted: 04.01.2017
- 35 -
A 82-year-old man presented to emergency
department (ED) with fatigue and headache.
His symptoms began about 5 hours ago.
On initial presentation, his Glascow Coma Scale
(GCS) was 15; blood pressure was 170/90
mmHg, pulse rate was 78 bpm, oxygen saturation
98%, body temperature was 36,4°C.
His physical and neurological examination
revealed no pathology including normal breath
sounds. His electrocardiography and his
laboratory results were normal, too. He was
sent to computed tomography (CT) of brain
for intracranial hemorrhage because of having
the worst headache in his life. His CT scan in
the emergency department revealed diffuse subarachnoid
hemorrhage (Figure 1). During his
wait in angiography, after an hour in his followups,
suddenly he had dyspnea. In his repeated
physical examination, bibasillary crepitant rales
were developed in his lung auscultation. His
vital signs were as his presentation except oxygen
saturation measured 88% and respiratory
rate was 32/min. He had oxygen therapy, he
was sent to CT for scaning thorax. Thorax CT
revealed bilateral pulmonary edema (Figure 2).
Half an hour later, his GCS score regressed to
8 in spite of supportive therapy. After endotracheal
intubation, the patient was sent to intensive
care unit for further therapy and follow-up.