Neurogenic pulmonary edema accompanying subarachnoid hemorrhage: case report

Neurogenic pulmonary edema (NPE) is defined as an acute pulmonary edema occurring after a central neurologic insult. It is associated with head injury and seizures, intracranial hemorrhage and stroke are among the other causes. Pathologies increasing intracranial pressure may cause excessive sympathetic discharge and lead to pulmonary vascular pressure changes and transcapillary fluid leakage. Hereby we present an acute respiratory failure in a 50-year old woman with subarachnoid hemorrhage (SAH) due to aneurysmal rupture of anterior communicating artery. The patient had a history of bronchial asthma and respiratory failure was thought to have occurred by radiocontrast induced airway hyper-responsiveness during cerebral angiography. No response to bronchodilator therapy, pinkish foamy sputum from the trachea, diffusely dense infiltrates on both lungs demonstrated by chest X-ray, normal echocardiography, and negative tracheal culture disproving pneumonia were among the factors leading to the diagnosis of NPE. Consistent with the diagnosis, the patient rapidly improved with mechanical ventilation and subsequent removal of the intracranial hematoma. After evaluation of the clinical course of our case, we recommend that NPE should be considered in the differential diagnosis of acute respiratory failure accompanying SAH. Keywords: Neurogenic pulmonary edema, subarachnoid hemorrhage Ozet Norojenik pulmoner odem, santral norojenik travma sonrasi olusan akut pulmoner odem tablosudur. Kafa travmasi ile iliskilidir ve nobetler, intrakraniyal kanama ve inme diger nedenleri arasindadir. Intrakraniyal basinci arttiran patolojik durumlar asiri sempatik uyarima yol acabilir ve pulmoner vaskuler basinc degisiklikleri ve transkapiller sivi kacagina neden olabilir. Bu yazida anterior komunikan arterin anevrizmal rupturune bagli subaraknoid kanamasi olan 50 yasinda bir kadinda gelisen akut respiratuvar yetmezlik olgusunu sunuyoruz. Hastanin bronsiyal astma oykusu vardi ve respiratuvar yetmezligin serebral anjiyografi sirasinda radyokontrasta karsi gelisen asiri havayolu duyarliligi ile olusmus olabilecegi dusunuldu. Bronkodilator tedaviye yanitsizlik, trakeadan pembe kopuklu balgam gelmesi, akciger grafisinde her iki tarafta yogun ve yaygin infiltrasyon olmasi, normal ekokardiyografi ve pnomoni ile uyusmayan negatif trakeal kultur, norojenik pulmoner odem tanisina goturen faktorler arasinda idi. Tani ile uyumlu sekilde, hasta mekanik ventilasyon ve daha sonra intrakraniyal hematomun bosaltilmasi ile hizlica iyilesti. Bu olgunun klinik seyrinden yola cikarak, subaraknoid kanamaya eslik eden akut respiratuvar yetmezligin ayirici tanisinda norojenik pulmoner odemin de dusunulmesini oneriyoruz. Anahtar sozcukler: Norojenik pulmoner odem, subaraknoid kanama