Severe Subarachnoid Hemorrhage With Pulmonary Edema Successfully Treated by Intra-aneurysmal Embolization Using Guglielmi Detachable Coils. Two Case Reports.

Abstract

A 48-year-old male and a 39-year-old female presented with subarachnoid hemorrhage (SAH) due to ruptured anterior communicating artery aneurysms. Both patients were comatose on admission. Chest radiography disclosed pulmonary edema. They were conservatively treated under controlled ventilation, but cardiopulmonary dysfunction persisted over 2 days. The patients were then treated by intraaneurysmal embolization with Guglielmi detachable coils (GDCs) 2 days after the onset. The postoperative courses were uneventful, and the patients showed full recovery from pulmonary edema and were discharged without neurological deficits. Neurogenic pulmonary edema is one of the serious complications of SAH, and is a leading cause of poor clinical outcome. The favorable outcomes of the present cases suggest that intra-aneurysmal embolization with GDCs is an excellent choice for the patients with severe aneurysmal SAH complicated with pulmonary edema, in whom conventional surgical treatment under general anesthesia is difficult to perform in the acute stage.

Subarachnoid Hemorrhage Complicated With Neurogenic Pulmonary Edema and Takotsubo-Like Cardiomyopathy

“…The patients are frequently hypotensive and hypoxic, despite the vigorous use of vasopressors and ventilation support, and coiling of the aneurysm has been advocated based on the potential risks of open surgery including general anesthesia. 10,14) On the other hand, aneurysm clipping under general anesthesia is feasible and safe in the acute phase for patients with NPE 34) or TCM. 19) In this study, only 8 of the 14 patients with NPE-TCM were hemodynamically and neurologically fit to undergo surgical or endovascular treatment, with 2 undergoing clipping surgery and 6 receiving coil embolization.…”

“…10,14) However, whether patients considered unfit for coiling may be treated immediately or surgery should be deferred at least for 2 weeks remains unclear. Since the number of patients with SAH complicated with NPE-TCM is relatively small, a multi-center cooperative study may be required to clarify the issue.…”

Unilateral neurogenic pulmonary oedema: An unusual cause for post-operative respiratory dysfunction following clipping of ruptured intracranial aneurysm

“…[67] Some reports suggest that endovascular treatment of aneurysm with Guglielmi Detachable Coils may improve NPE. [8] However, Brewer et al . reported two cases of NPE following angioplasty for refractory cerebral vasospasm following SAH.…”

Ateşli Silah Yaralanması Sonrası Nörojenik Pulmoner Ödem

“…Nörojenik pulmoner ödem (NPÖ), açık veya kapalı kafa travması, beyin tümö-rü, intraserebral ve subaraknoid hemoroji, servikal spinal kord yaralanması, epileptik ve konvulsif bozukluklar, vertebral arter oklüzyonu gibi santral sinir sistemi (SSS)'ni etkileyen herhangibir hastalığın ardından, akciğerlerde vasküler konjesyon, parankimal ödem ve hemorojinin meydana geldiği klinik bir durumdur (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13).…”