title: Neurogenic pulmonary oedema misdiagnosed as acute myocardial infarction in a comatose patient.
abstract: BACKGROUND
  We report a case of neurogenic pulmonary oedema (NPO) following massive left cerebral infarct, which was initially misdiagnosed as acute myocardial infarction (AMI).
  
  
  METHODS
  This 52-year-old man presented with acute loss of consciousness with normal brain computed tomography (CT). He was treated as non-ST-elevation AMI complicated with pulmonary oedema based on findings of chest radiograph (bilateral pulmonary oedema), electrocardiogram (marked ST-T changes in leads V3 to V6), and cardiac enzymes [elevated creatinine kinase (CK) and CK-MB]. However, coronary angiogram and serial cardiac enzymes were inconclusive. Anisocoria developed after admission and a repeat brain CT was evident for large left cerebral infarct.
  
  
  METHODS
  Decompressive craniectomy was carried out.
  
  
  RESULTS
  Mortality.
  
  
  CONCLUSIONS
  The diagnosis of NPO can be challenging when it occurs without abnormal findings on preliminary brain CT. It can be mistaken for cardiogenic pulmonary oedema secondary to AMI.
authors.affiliation: Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taiwan.
authors.forename: Vei Ken
authors.initials: VK
authors.lastname: Seow
authors.forename: Shih Yu
authors.initials: SY
authors.lastname: Ko
authors.forename: Meng Kai
authors.initials: MK
authors.lastname: Huang
authors.forename: Chee Fah
authors.initials: CF
authors.lastname: Chong
mesh_terms: D002544:Cerebral Infarction / Q000503:physiopathology; D003128:Coma; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D011654:Pulmonary Edema / Q000175:diagnosis* / Q000503:physiopathology; D013902:Radiography, Thoracic; D013624:Taiwan