Neurogenic pulmonary edema caused by spontaneous cerebellar hemorrhage: A fatal case report

Abstract

Background: Neurogenic pulmonary edema (NPE) is a clinical syndrome characterized by an acute increase of pulmonary interstitial and alveolar fluid. It could result from a significant central nervous system (CNS) insult such as intracranial hemorrhage. However, NPE as a major presenting manifestation of cerebellar hemorrhage was seldom reported.

Case description: We introduce a rare case of a 34-year-old woman suffering from a fulminant NPE in parallel with a spontaneous cerebellar hemorrhage. Although appropriate supportive measures were taken in the neuroscience care unit, the patient failed to survive hypoxemia within 28 h after hospital admission.

Conclusion: Pathological lesions of the cerebellum may initiate a cascade of reactions including massive sympathetic discharge and catecholamine storm, leading to a dysfunction of both cardiovascular and respiratory systems. By far, no effective therapeutic strategies have been utilized to treat such a situation. Our present report would shed light on the underlying mechanism of NPE.

Keywords: Respiratory dysfunction; neurogenic pulmonary edema; spontaneous cerebellar hemorrhage.

Figure 1

Clinical course and main events of case. ED: Emergency department, NCU: Neuroscience care unit, NPE: Neurogenic pulmonary edema

Figure 2

A non-contrast computed tomography scan demonstrates acute large hemorrhage in the cerebellar vermis and right hemispheres (a) with blood in the ventricular system resulting in a mild hydrocephalus (b)

Figure 3

Chest radiograph taken 2 h after admission showed diffuse symmetric alveolar infiltrates, indicating pulmonary edema

Figure 4

Repeated chest imaging confirmed bilateral ground-glass opacities and diffuse interstitial in fi ltrates (worse on the left side)