뇌동맥류성 지주막하 출혈 환자에서 신경인성 폐부종

Abstract

A neurogenic pulmonary edema(NPE) following an anerurysmal subarachnoid hemorrhage(SAH) is a rare but devastating complication. The authors analyzed the clinical characteristics, therapeutic problems and management results from our cases in order to throughly evaluate for future theraperutic guide for such patients. There were seven patients diagnosed as NPE out of 546 patients who were admitted within one day following a SAH(1.3%) during the past 13 years. They were relatively young(average 51.3 years). had poor clinical grades on admission and had large amount of SAH. Hypotension and hypoxia on admission were also characteristics. Good results were obtained in 4 of the 7 patients by rapid correction of hypoxia and hypotension with intubation, mechanical ventilation and with positive end-expiratory pressure, diuretics and hypertensive drugs. We conclude that NPE following SAH may be triggered by an acute rise in intracranial pressure followed by a simultaneous decrease of the function of the heart and lungs. Although the patients had shown fulminant clinical state on admission, we recommend aggressive management of these patients because some of these patients can recover without neurological deficits by an aggressive treatment.