Neurogenic pulmonary edema due to traumatic brain injury: evidence of cardiac dysfunction.
BACKGROUND
Acute neurogenic pulmonary edema, a common and underdiagnosed clinical entity, can occur after virtually any form of injury of the central nervous system and is a potential early contributor to pulmonary dysfunction in patients with head injuries.


OBJECTIVE
To explore myocardial function in patients with evident neurogenic pulmonary edema after traumatic head injury.


METHODS
During a 1-year period in a university hospital in Sfax, Tunisia, information was collected prospectively on patients admitted to the 22-bed intensive care unit because of isolated traumatic head injury who had neurogenic pulmonary edema. Data included demographic information, vital signs, neurological status, physiological status, and laboratory findings. All of the patients had computed tomography and plain radiography of the neck and determination of cardiac function.


RESULTS
All 7 patients in the sample had cardiac dysfunction. Evidence of myocardial damage was confirmed by echocardiography in 3 patients, pulmonary artery catheterization in 3 patients, and/or postmortem myocardial biopsy in 4 patients. Echocardiography studies, repeated 7 days after the initial study in one patient and 90 days afterward in another, showed complete improvement in wall motion, with a left ventricular ejection fraction of 0.65.


CONCLUSIONS
All patients who had neurogenic pulmonary edema due to traumatic head injury had myocardial dysfunction. The mechanisms of the dysfunction were multiple. The great improvement in wall motion seen in 2 patients indicated the presence of a stunned myocardium. Further studies are needed to understand the mechanisms of this cardiac dysfunction.
Bahloul
Mabrouk
M
Service de Réanimation Médicale, Centre Hospitalier Universitaire Habib Bourguiba, Sfax, Tunisia. bahloulmab@yahoo.fr
Chaari
Anis N
AN
Kallel
Hatem
H
Khabir
Abdelmajid
A
Ayadi
Adnène
A
Charfeddine
Hanène
H
Hergafi
Leila
L
Chaari
Adel D
AD
Chelly
Hedi E
HE
Ben Hamida
Chokri
C
Rekik
Noureddine
N
Bouaziz
Mounir
M
D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000150:complications*; D002407:Catheterization, Swan-Ganz; D002648:Child; D004452:Echocardiography; D004562:Electrocardiography; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000175:diagnosis / Q000209:etiology*; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed