Abstract
Aim
Dyspnea is one of the most common causes of emergency department admission. In this case report, we aimed to draw attention to the intracranial aneurysm rupture and non-cardiogenic neurogenic pulmonary edema (NPE) and emergency management during the follow-up of a young cooperative patient who presented with dyspnea.
Case
A 32-year-old female patient presented to the emergency department with sudden onset of respiratory distress. Heart rate of the patient was 140/min, SpO2;80%, respiratory rate;35/min. She had a Glasgow Coma Scale score of 15 on her physical examination and no pathology was detected in her neurological examination. Pulmonary auscultation revealed bilateral rhales in all zones and pink foamy phlegm was coming from the patient's mouth.The patient's respiratory status worsened and she was unconscious. Shee was sedated with midazolam and intubated. With all examination and examination results, the patient was diagnosed with neurogenic pulmonary edema. The patient was admitted to the intensive care unit. Seven days after admission to hospital, she died.
Conclusion
NPE is a type of pulmonary edema that is very mortal and can be presented with only dyspnea as a symptom rather than neurological findings. Especially in patients with sudden onset and rapidly progressing respiratory distress, we should remember that even if there is no neurological symptoms, intracranial hemorrhage must be considered in order to diagnose and treat the patient optimally.
References
- 1. Ahmed A, Graber MA Evaluation of the adult with dyspnea in the emergency department. UpToDate, Waltham, MA. Web site. Available at: https://www.uptodate.com/contents/evaluation-of-the-adult-with-dyspnea-in-the-emergency-department. Accessed Feb 15, 2020.
- 2. Davison DL, Terek M, Chawla LS. Neurogenic pulmonary edema, Crit Care, 2012(16);2:212, doi: 10.1186/cc11226.
- 3. Mierzewska-Schmidt M, Gawecka A. Neurogenic stunned myocardium - do we consider this diagnosis in patients with acute central nervous system injury and acute heart failure?. Anaesthesiol Intensive Ther, 2015;47(2):175-80, doi: 10.5603/AIT.2015.0017.
- 4. Rordorf G, McDonald C. https://www.uptodate.com/contents/spontaneous-intracerebral-hemorrhage-pathogenesis-clinical-features-and-diagnosis,(2010) Waltham, MA.
- 5. Farooq H, Veerareddy S, Silber E. Neurogenic pulmonary oedema: a rare cause of maternal collapse. BMJ Case Rep. 2017 Jun 26;2017. pii: bcr2016217375. doi: 10.1136/bcr-2016-217375.
- 6. Cruz AS, Menezes S, Silva M. Neurogenic pulmonary edema due to ventriculo-atrial shunt dysfunction: a case report. Braz J Anesthesiol. 2016(66);2:200-3.doi: 10.1016/j.bjane.2013.10.009.
Abstract
Amaç
Dispne acil servise başvuruların en sık görülen nedenleri arasındadır. Bu olgu sunumunda nefes darlığı şikayeti ile başvuran bilinci açık oryante, koopere genç hastanın takibi sırasında rastlanan intrakranial anevrizma rüptürü ve bu patolojinin ortaya çıkardığı non-kardiyojenik, nörojenik pulmoner ödem (NPÖ) tanısı ve acil yönetimine dikkat çekmeyi amaçladık.
Olgu
Otuz iki yaşında kadın hasta, yarım saat önce aniden başlayan solunum sıkıntısı ile acil servise başvurdu. Bilinen hastalığı olmayan hastanın başvurusu anında nabız:140/dk, SpO2: %80, solunum sayısı:35/dk idi. Fizik muayenesinde Glaskow Koma Skalası skoru 15 olan, nörolojik muayenesinde patoloji saptanmadı. Akciğer oskültasyonunda tüm zonlarda bilateral ral tespit edildi ve hastanın ağzından pembe köpüklü balgam gelmekteydi. Genel durumu kötüleşen hasta midazolam ile sedatize edildi ve entübe edildi. Tüm tetkik ve muayene sonuçları ile hastaya nörojenik pulmoner ödem tanısı konuldu. Hasta yoğun bakıma yatırıldı. Hasteneye başvurusundan 7 gün sonra kardiyak arrest sonucu exitus kabul edildi.
Sonuç
NPÖ, santral bulgularla gelebildiği gibi sadece dispne şikayetiyle de gelebilen, mortal seyreden, merkezi sinir sistemi hasarı sonrası görülen, akılda tutulması gereken bir pulmoner ödem tipidir. Özellikle ani başlangıçlı ve hızlı ilerleyen solunum sıkıntılı hastalarımızda klinik bulgularda santral hadiseyi düşündürecek bulgu olmasa dahi aklımıza getirmeli, tanı ve tedavisini optimal şekilde yapmalıyız.
References
- 1. Ahmed A, Graber MA Evaluation of the adult with dyspnea in the emergency department. UpToDate, Waltham, MA. Web site. Available at: https://www.uptodate.com/contents/evaluation-of-the-adult-with-dyspnea-in-the-emergency-department. Accessed Feb 15, 2020.
- 2. Davison DL, Terek M, Chawla LS. Neurogenic pulmonary edema, Crit Care, 2012(16);2:212, doi: 10.1186/cc11226.
- 3. Mierzewska-Schmidt M, Gawecka A. Neurogenic stunned myocardium - do we consider this diagnosis in patients with acute central nervous system injury and acute heart failure?. Anaesthesiol Intensive Ther, 2015;47(2):175-80, doi: 10.5603/AIT.2015.0017.
- 4. Rordorf G, McDonald C. https://www.uptodate.com/contents/spontaneous-intracerebral-hemorrhage-pathogenesis-clinical-features-and-diagnosis,(2010) Waltham, MA.
- 5. Farooq H, Veerareddy S, Silber E. Neurogenic pulmonary oedema: a rare cause of maternal collapse. BMJ Case Rep. 2017 Jun 26;2017. pii: bcr2016217375. doi: 10.1136/bcr-2016-217375.
- 6. Cruz AS, Menezes S, Silva M. Neurogenic pulmonary edema due to ventriculo-atrial shunt dysfunction: a case report. Braz J Anesthesiol. 2016(66);2:200-3.doi: 10.1016/j.bjane.2013.10.009.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Case Report |
| Authors | |
| Publication Date | March 30, 2020 |
| Published in Issue | Year 2020 Volume: 3 Issue: 1 |
