Pulmonary Edema and Stunned Myocardium in Subarachnoid Hemorrhage

Abstract

Aneurysmal subarachnoid hemorrhage is a life-threatening event that can cause permanent disability. This life-threatening event can be further complicated by subsequent cardiac and pulmonary disability. The presence of a neurogenic cardiomyopathy and pulmonary edema increases the morbidity and mortality of patients who suffer from aneurysmal subarachnoid hemorrhage. In this paper, we discuss a 39-year-old woman who presented to the emergency department (ED) with a chief complaint of a pounding headache with associated nausea and vomiting for the past three days. She had a past medical history significant only for migraines. During her stay in the ED, she began to exhibit signs of altered consciousness, hemoptysis, and respiratory compromise. Neuroimaging showed evidence of subarachnoid hemorrhage. The exact source of her subarachnoid hemorrhage could not be located with neuroimaging or angiography. Her clinical course was complicated by pulmonary edema and neurogenic stunned myocardium, and is still ongoing.

Heartbroken Child: A Rare Case Report of Neurogenic Pulmonary Edema and Takotsubo Cardiomyopathy following Recurrent Medulloblastoma Excision with Possible Aetio-Patho-Bio-Physiological Mechanisms

“…Most common causes in adults are seen in postmenopausal females, which mainly include emotional and psychological stress [1,4]. Organic causes include subarachnoid haemorrhage [12][13][14][15], cancer pain [16], pheochromocytoma [17], and posterior fossa haemorrhage [9] among other few. The classical description involves the apical and basal heart and hence also described as apical ballooning syndrome [3,16].…”

Neurogenic pulmonary edema in subarachnoid hemorrhage: relevant clinical concepts

“…This condition refers to bleeding into the subarachnoid space, which is located between the arachnoid and pia layers [ 2 ]. The most common cause that triggers this neurological disorder is trauma, and among the non-traumatic causes, 80% are generated by ruptured aneurysms of the intracranial circulation [ 3 ], although they can also occur secondary to other pathological entities such as Moya–Moya disease, arteriovenous malformations, vasculitis or amyloid angiopathy [ 3 – 5 ].…”