Neurogenic pulmonary oedema

Description

A 42-year-old healthy woman was found unresponsive with a peripheral oxygen saturation of 80% after having a thunderclap headache. She had copious pink respiratory secretions. Emergency intubation was performed. Cerebral CT showed subarachnoid haemorrhage from a right internal carotid aneurysm. Thoracic CT revealed extensive bilateral patchy consolidations with air bronchograms, mainly in dependent lung areas (figure 1: coronal plane; figure 2: transverse plane). Her PaO₂/FiO₂ ratio was initially 157 mm Hg and improved significantly over 24 hours. These findings were consistent with acute neurogenic pulmonary oedema (ie, interstitial and alveolar fluid) which results from changes in cardiopulmonary physiology caused by extreme sympathetic discharge after an acute neurological insult. Serial echocardiography showed initially impaired left ventricular function that fully recovered over 2 days. Extubation was successful after 30 hours. The clinical course supports the diagnosis of neurogenic pulmonary oedema. After a complicated recovery (due to vasospasms and hydrocephalus),...

http://ift.tt/2DpoieA