Neurogenic Pulmonary Edema After Subarachnoid Hemorrhage

CASE REPORTA56-year-oldwomanwithamedicalhistoryofhyperten-sion suddenly fell to thegroundwhile brushing her teeth.Her family found that she had stopped breathing andchecked the pulse of the carotid artery, which could notbe palpated. Her family immediately initiated bystandercardiopulmonary resuscitation and called emergencymedical services. The patient had return of spontaneouscirculation 15 min after the onset of cardiopulmonaryarrest. On arrival at our emergency department, the pa-tient’s vital signs were the following: blood pressure102/62 mm Hg, heart rate 86 beats/min, and body tem-perature 35.9 C. Her consciousness level was E1V1M1on the Glasgow Coma Scale. She had miotic pupilswith loss of light reflex. Physical examination revealeddiffuse bilateral crackles. Despite intubation and manualventilation with oxygen administration (10 L/min), sheremained hypoxic, with a partial pressure of oxygen on39.8 mm Hg on arterial blood gas. During theintubation,pink frothy sputum was found in her trachea. A chestx-ray study showed bilateral patchy opacities withoutcardiomegaly. Due to her sudden loss of consciousnessand persistent hypoxia despite recovery from circulat-ion insufficiency, we performed a computed tomo-graphy (CT) of her brain and chest to assess for theetiology of her arrest. Diffuse subarachnoid hemorrhage(Figure 1) and acute pulmonary edema were demon-strated (Figure 2) on the CT scans.DISCUSSIONNeurogenic pulmonary edema is a rare but life-threatening complication in patients with central nervoussystem lesions and is defined as the sudden developmentof hypoxemic respiratory failure after a central nervoussystem event, which cannot be attributed to other causes