title: Endovascular Treatment for Aneurysmal Subarachnoid Hemorrhage with Neurogenic Pulmonary Edema in the Acute Stage.
abstract: OBJECTIVE
  Severe neurogenic pulmonary edema (NPE) can occur in a variety of brain insults, including subarachnoid hemorrhage (SAH), and severe case of NPE can cause devastating consequences. But the literature on the treatment strategy about aneurysmal SAH with NPE is very scant. We present that SAH patients with severe NPE, who were treated first by embolization of aneurysm followed by insertion of lumbar spinal drainage, had comparatively good outcome.
  
  
  METHODS
  We present 12 consecutive cases of aneurysmal SAH with NPE in the acute stage, which were treated by endovascular treatment between April 2002 and December 2012. We classified the patients according to the Hunt and Hess grading system as follows: grade-3 (1 patient), grade-4 (4 patients), and grade-5 (7 patients). All patients needed respiratory management, with the assistance of a ventilator, and underwent endovascular treatment for the ruptured aneurysms within 72 hours from onset. For all the patients, immediately after the endovascular treatment, we performed lumbar spinal drainage.
  
  
  RESULTS
  The pulmonary edema disappeared rapidly after respiratory management and endovascular treatment. The outcomes were as follows: good recovery (GR; 3 patients), moderate disability (MD; 4 patients), severe disability (SD; 3 patients), and death (D; 2 patients). Five patients (42%) developed pneumonia, and we postponed extubation until recovery from pneumonia. The cause for severe disability and death was symptomatic vasospasm and primary brain damage. No patients had rebleeding from ruptured aneurysms.
  
  
  CONCLUSIONS
  Endovascular treatment for ruptured aneurysm and placement of lumbar spinal drainage is an excellent treatment option for severe SAH with NPE.
authors: Hiroshima City Hospital, Department of Neurological Surgery, Hiroshima, Japan.
authors: Toshinari
authors: T
authors: Meguro
authors: Tomoyuki
authors: T
authors: Tanabe
authors: Kenichiro
authors: K
authors: Muraoka
authors: Kinya
authors: K
authors: Terada
authors: Nobuyuki
authors: N
authors: Hirotsune
authors: Shigeki
authors: S
authors: Nishino
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000628:therapy*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000209:etiology / Q000628:therapy*; D013129:Spinal Puncture / Q000379:methods*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome