Delayed Neurogenic Pulmonary Edema Resulting from a Ruptured Vertebral Aneurysm : A Case Report

Neurogenic pulmonary edema (NPE )following subarachnoidhemorrhage (SAH )usually appears immediate− ly after the ictus and delayed onset is rare . Herein we present a case of delayed NPE following SAII due to a vertebral aneurysmal rupture . The vertebral aneurysm 、vas clipped at l day after the SAH , and delayed NPE appeared 2 days later, wchich became worse and parenchymal lesion invdving the entire lung. It should be noted that after SAH , NPE usually develops soon but in some cases it can develop in several days. To treat the condition , an early diagnosis must be established so that prolnpt therapy can be initiated . If delayed NPE is suspected , based on chest X −rays and gas analysis , then hypervolemic therapy for vasospasms should not be instituted . For cases manifesting severe NPE , therapies should include artificial ventilation with a positive end −expiratory pressure and adnlinistration of dobutamine, which were effective in our case . (Received May 23,1994 ;accepted August 31,1994)