Abstract
In this paper, twenty-four patients with acute neurogenic pulmonary edema (NPE) following subarachnoid hemorrhage (SAH) are presented, and clinical features are discussed. Among the 503 patients admitted for SAH during a seven year period, 24 cases (4.8%) involved NPE associated with SAH. Seventeen (70.8%) of these were admitted within 60 minutes after the onset of SAH. Fourteen patients were in Hunt & Hess SAH Grade V and ten in Grade IV. The hemodynamic study using the Swan-Ganz catheterization method noted an increase in pulmonary capillary wedge pressure and mean pulmonary arterial pressure in three patients. Seventeen patients (70.8%) were treated by assisted ventilation with positive end-expiratory pressure within three days. However, thirteen (76.5%) of these 17 patients died from increased intracranial pressure due to severe SAH. The remaining four patients underwent surgery for intracranial aneurysm. Two of those recovered well but two had severe disabilities.
This result implies that acute pulmonary edema associated with severe SAH can be successfully treated with assisted ventilation. However, the direct surgical treatment of intracranial aneurysm has a high incidence of morbidity and mortality because of a high preoperative SAH grade.
