Korean J Anesthesiol.  2007 Sep;53(3):S52-S57. 10.4097/kjae.2007.53.3.S52.

Neurogenic Cardiopulmonary Instability with Pulmonary Edema after a Traumatic Head Injury: A case report

• Kim DK
• Lee KM
• Kwon WK
• Jeong SM

• KMID: 2039650
• DOI: http://doi.org/10.4097/kjae.2007.53.3.S52

Abstract

There are substantial clinical and experimental evidences to support the hypothesis that catecholamine surge causes cardiac failure and pulmonary edema after the acute neurological events. A previous healthy 74-year-old man was submitted to an emergency craniotomy for the evacuation of the delayed subdural hemorrhage after a motorcycle accident. After anesthetic induction, profound hypotension and progressive decrease of arterial oxygen tension developed and continued for several hours in spite of fluid loading and inotropic support with dopamine in combination with dobutamine. Electrocardiographic changes and increase of serum cardiac isoenzymes suggesting myocardial infarction were absent. On auscultation, crackles were detected in both lung bases, indicating pulmonary edema. On the basis of the assumption that left ventricular dysfunction was combined with the acute pulmonary edema, with a possible neurogenic component, aggressive management including dobutamine in combination with isosorbide dinitrate was instituted. As a result, these cardio-respiratory complications rapidly resolved without any neurologic sequelae.

Keyword

intracerebral hemorrhage; neurogenic pulmonary edema; ventricular dysfunction

MeSH Terms

Aged
Auscultation
Cerebral Hemorrhage
Craniocerebral Trauma*
Craniotomy
Dobutamine
Dopamine
Electrocardiography
Emergencies
Head*
Heart Failure
Hematoma, Subdural
Humans
Hypotension
Isoenzymes
Isosorbide Dinitrate
Lung
Motorcycles
Myocardial Infarction
Oxygen
Pulmonary Edema*
Respiratory Sounds
Ventricular Dysfunction
Ventricular Dysfunction, Left
Dobutamine
Dopamine
Isoenzymes
Isosorbide Dinitrate
Oxygen