title: Neurogenic pulmonary edema due to ventriculo-atrial shunt dysfunction: a case report.
abstract: OBJECTIVE
  Pulmonary edema is caused by the accumulation of fluid within the air spaces and the interstitium of the lung. Neurogenic pulmonary edema is a clinical syndrome characterized by the acute onset of pulmonary edema following a significant central nervous system insult. It may be a less-recognized consequence of raised intracranial pressure due to obstructive hydrocephalus by blocked ventricular shunts. It usually appears within minutes to hours after the injury and has a high mortality rate if not recognized and treated appropriately.
  
  
  METHODS
  We report a patient with acute obstructive hydrocephalus due to ventriculo-atrial shunt dysfunction, proposed to urgent surgery for placement of external ventricular drainage, who presented with neurogenic pulmonary edema preoperatively. She was anesthetized and supportive treatment was instituted. At the end of the procedure the patient showed no clinical signs of respiratory distress, as prompt reduction in intracranial pressure facilitated the regression of the pulmonary edema.
  
  
  CONCLUSIONS
  This report addresses the importance of recognition of neurogenic pulmonary edema as a possible perioperative complication resulting from an increase in intracranial pressure. If not recognized and treated appropriately, neurogenic pulmonary edema can lead to acute cardiopulmonary failure with global hypoperfusion and hypoxia. Therefore, awareness of and knowledge about the occurrence, clinical presentation and treatment are essential.
authors.affiliation: Anesthesiology Department, Centro Hospital São João, Porto, Portugal. Electronic address: fyzzita@gmail.com.
authors.forename: Ana Sofia
authors.initials: AS
authors.lastname: Cruz
authors.affiliation: Anesthesiology Department, Hospital Distrital de Santarém, Santarém, Portugal.
authors.forename: Sónia
authors.initials: S
authors.lastname: Menezes
authors.affiliation: Anesthesiology Department, Centro Hospital São João, Porto, Portugal.
authors.forename: Maria
authors.initials: M
authors.lastname: Silva
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000473:pathology; D019586:Intracranial Hypertension / Q000150:complications* / Q000628:therapy; D011654:Pulmonary Edema / Q000209:etiology* / Q000473:pathology / Q000628:therapy
keywords: Edema pulmonar neurogênico; Hidrocefalia; Hydrocephalus; Neuroanestesia; Neuroanesthesia; Neurogenic pulmonary edema