title: Neurogenic Pulmonary Edema in Aneurysmal Subarachnoid Hemorrhage.
abstract: Neurogenic pulmonary edema (NPE) is observed in cerebral injuries and has an impact on treatment results, being a predictor of fatal prognosis. In this study we retrospectively reviewed medical records of 250 consecutive patients with aneurysmal subarachnoid hemorrhage (SAH) for the frequency and treatment results of NPE. The following factors were taken under consideration: clinical status, aneurysm location, presence of NPE, intracranial pressure (ICP), and mortality. All patients had plain- and angio-computer tomography performed. NPE developed most frequently in case of the aneurysm located in the anterior communicating artery. The patients with grades I-III of SAH, according to the World Federation of Neurosurgeons staging, were immediately operated on, while those with poor grades IV and V had only an ICP sensor's implantation procedure performed. A hundred and eighty five patients (74.4 %) were admitted with grades I to III and 32 patients (12.8 %) were with grade IV and V each. NPE was not observed in SAH patients with grade I to III, but it developed in nine patients with grade IV and 11 patients with grade V. Of the 20 patients with NPE, 19 died. Of the 44 poor grade patients (grades IV-V) without NPE, 20 died. All poor grade patients had elevated ICP in a range of 24-56 mmHg. The patients with NPE had a greater ICP than those without NPE. Gender and age had no influence on the occurrence of NPE. We conclude that the development of neurogenic pulmonary edema in SAH patients with poor grades is a fatal prognostic as it about doubles the death rate to almost hundred percent.
authors: Faculty of Health Sciences and Physical Education, The Kazimierz Pulaski University of Technology and Humanities, 27 Chrobrego Street, 26-600, Radom, Poland.
authors: A
authors: A
authors: Saracen
authors: Faculty of Health Sciences and Physical Education, The Kazimierz Pulaski University of Technology and Humanities, 27 Chrobrego Street, 26-600, Radom, Poland. zbigniew.kotwica@neostrada.pl.
authors: Z
authors: Z
authors: Kotwica
authors: Epidemiological Response Center, Polish Armed Forces, Warsaw, Poland.
authors: A
authors: A
authors: Woźniak-Kosek
authors: Department of Neurosurgery, Medical University of Lodz, Lodz, Poland.
authors: P
authors: P
authors: Kasprzak
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging*; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011654:Pulmonary Edema / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: Cerebral injury; Intracranial aneurysm; Intracranial pressure; Mortality; Pulmonary edema; Subarachnoid hemorrhage