Diagnosis and treatment of spontaneous subarachnoid hemorrhage complicated with neurogenic pulmonary edema

LI Jie; JIANG Zheng-yuan; RAN jun-min; KANG hong-da

doi:10.13798/j.issn.1009-153X.2024.10.005

Abstract：Objective To summarize the treatment experience of spontaneous subarachnoid hemorrhage complicated with neurogenic pulmonary edema.Methods A retrospective analysis was conducted on the clinical data of 17 patients with spontaneous subarachnoid hemorrhage complicated with neurogenic pulmonary edema admitted from January 2018 to December 2022.Results All 17 patients received timely and standardized treatment through the stroke center's green channel,multidisciplinary team(MDT)diagnosis and treatment,and ICU care upon admission.All patients presented with varying degrees of dyspnea at admission,with 3 cases of respiratory failure stabilizing after rescue,and 14 cases having good respiratory function.All 17 cases underwent emergency DSA examination,and 14 cases(82.4%)were diagnosed with ruptured aneurysms,with a total of 17 aneurysms identified;3 cases(17.6%)had unknown causes.The patients with ruptured aneurysms underwent interventional embolization treatment,including 12 cases of simple embolization and 5 cases of stent-assisted embolization.The patients with ruptured aneurysms were treated in the ICU for 1～2 weeks after the operation;the 3 cases without identified aneurysms were treated in the general ward.During hospitalization,there were no deaths.At the 6-month follow-up after discharge,the GCS score was 13 in 1 case and 15 in 16 cases;the classification of the Activities of Daily Living Scale was grade 0 in 9 cases,grade 1 in 6 cases,and grade 2 in 2 cases.Conclusions Comprehensive treatment is necessary for spontaneous subarachnoid hemorrhage complicated with neurogenic pulmonary edema.The role of the stroke center's green channel,MDT,and ICU should be fully utilized.At the same time,etiological treatment should be the main focus in clinical practice,with attention also given to respiratory system treatment,fluid volume restriction,and nutritional support.