抄録
Three cases of acute pulmonary edema following subarachnoid hemorrhaging due to rupture of an intracranial aneurysm were reported. Two cases had an aneurysm of the internal carotid artery and the other case had an aneurysm of the middle cerebral artery. Each case showed signs of pulmonary edema at the time of admission.
Blood gas analysis, chest roentgenography, CVP monitoring and ECG recording were repeated. The pulmonary arterial and wedge pressures were measured by a Swan-Ganz catheter inserted into the pulmonary artery in one case.
The interval between the subarachnoid hemorrhage attack and the evidence of pulmonary edema was 3, 6 and 20 hours respectively. Initial blood gas analysis revealed severe hypoxemia and the chest roentgenogram showed a typical pattern of pulmonary edema (snow storm or butterfly pattern). CVP was normal in two cases. Initial pulmonary arterial and wedge pressures were elevated and were normalized after 26 hours in one patient.
Although one case recovered from pulmonary edema by oxygen inhalation via a face mask, the other two needed artifitial ventilation with PEEP to maintain adequate arterial PO2. Respiratory care was successful in each case. Two patients were discharged without major neurological deficits after clipping of the aneurysm. The other case died of a vasospasm on the 8th day after the subarachnoid hemorrhage.
The importance of early diagnosis and respiratory care for the treatment of acute pulmonary edema following rupture of intracranial aneurysm was stressed.
