Inamasu Joji, Nakatsukasa Masashi, Mayanagi Keita, Miyatake Satoru, Sugimoto Keiko, Hayashi Takuro, Kato Yoko, Hirose Yuichi
Department of Neurosurgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
Neurol Med Chir (Tokyo). 2012;52(2):49-55. doi: 10.2176/nmc.52.49.
Patients with poor-grade subarachnoid hemorrhage (SAH) are often complicated with acute cardiopulmonary dysfunctions, particularly neurogenic pulmonary edema (NPE) and takotsubo-like cardiomyopathy (TCM). This study retrospectively investigated the incidence, demographics, clinical characteristics, and outcomes of patients with SAH complicated with both NPE and TCM (NPE-TCM). The effects of aneurysm location and other clinical variables on the incidence of NPE-TCM were also investigated. Among 234 SAH patients treated during 5-year period, 16 (7%) presented with NPE, and transthoracic ultrasonography revealed that 14 of these 16 patients (88%) also had TCM. All 14 patients with NPE-TCM had poor-grade SAH (World Federation of Neurosurgical Societies grades IV and V). Ruptured posterior circulation aneurysm was predictive of NPE-TCM, but other clinical variables were not. Eight of the 14 patients with NPE-TCM could undergo treatment for ruptured aneurysm. Long-term outcomes were favorable in 5 of the 8 patients. Grade IV SAH patients had significantly better outcomes than grade V patients. TCM develops frequently in SAH patients presenting with NPE, and transthoracic ultrasonography should be conducted routinely in that population. Patients with ruptured posterior circulation aneurysm may have elevated risk of developing NPE-TCM. Endovascular obliteration of the aneurysm may be preferable to open surgery, but the optimal treatment modality needs to be evaluated further. Considering the limited number of SAH patients complicated with NPE-TCM, a multi-center cooperative study may be required.
低分级蛛网膜下腔出血（SAH）患者常并发急性心肺功能障碍，尤其是神经源性肺水肿（NPE）和应激性心肌病（TCM）。本研究回顾性调查了SAH并发NPE和TCM（NPE-TCM）患者的发病率、人口统计学特征、临床特征及预后。还研究了动脉瘤位置和其他临床变量对NPE-TCM发病率的影响。在5年期间接受治疗的234例SAH患者中，16例（7%）出现NPE，经胸超声心动图显示这16例患者中有14例（88%）也患有TCM。所有14例NPE-TCM患者均为低分级SAH（世界神经外科协会分级IV级和V级）。后循环动脉瘤破裂是NPE-TCM的预测因素，但其他临床变量不是。14例NPE-TCM患者中有8例能够接受破裂动脉瘤治疗。8例患者中有5例长期预后良好。IV级SAH患者的预后明显优于V级患者。在出现NPE的SAH患者中，TCM经常发生，该人群应常规进行经胸超声心动图检查。后循环动脉瘤破裂的患者发生NPE-TCM的风险可能升高。动脉瘤的血管内闭塞可能比开放手术更可取，但最佳治疗方式需要进一步评估。考虑到并发NPE-TCM的SAH患者数量有限，可能需要进行多中心合作研究。
