Neurogenic pulmonary edema during intracranial endovascular therapy.
Neurogenic pulmonary edema (NPE) is a well-known complication of acute brain injury. Neurogenic stunned myocardium (NSM) occurs clinically in a significant subset of patients with NPE. A 49-year-old woman developed refractory cerebral vasospasm requiring angioplasty following a subarachnoid hemorrhage. During angioplasty, NPE with NSM manifested as acute pulmonary edema associated with elevated pulmonary artery occlusion pressure and reduced cardiac output. Evaluations disclosed a right insular infarction, cardiac wall motion abnormalities, and electrocardiographic characteristics of NSM. The NSM completely resolved, and the neurological outcome was good. A 56-year-old woman developed NPE during complicated coil embolization of an internal carotid artery aneurysm. Cardiac function was normal, and the NPE resolved with a brief period of mechanical ventilation and diuresis. The delayed appearance of NSM and NPE during endovascular therapy in these patients implies a degree of risk for sympathetically mediated cardiopulmonary dysfunction during complex intracranial endovascular procedures.
Brewer
Randall P
RP
Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA. brewe019@mc.duke.edu
Borel
Cecil O
CO
D000208:Acute Disease; D017130:Angioplasty / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000209:etiology*; D013902:Radiography, Thoracic; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000209:etiology; D020301:Vasospasm, Intracranial / Q000209:etiology* / Q000601:surgery*