Manto Andrea, De Gennaro Angela, Manzo Gaetana, Serino Antonietta, Quaranta Gaetano, Cancella Claudia
Neuroradiology Unit, Umberto I Hospital; Nocera Inferiore, Salerno, Italy -
Department of Biomorphological and Functional Sciences, Federico II University; Naples, Italy.
Neuroradiol J. 2014 Jun;27(3):356-60. doi: 10.15274/NRJ-2014-10035. Epub 2014 Jun 17.
Aneurysmal subarachnoid hemorrhage (SAH) may be associated with acute cardiopulmonary complications, like neurogenic pulmonary edema (NPE) and Takotsubo-like cardiomyopathy (TCM). These dysfunctions seem to result from a neurogenically induced overstimulation of the sympathetic nervous system through the brain-heart connection and often complicate poor grade aneurysmal SAH. The optimal treatment modality and timing of intervention in this clinical setting have not been established yet. Early endovascular therapy seems to be the fitting treatment in this particular group of patients, in which surgical clipping is often contraindicated due to the added risk of craniotomy. Herein we describe the case of a woman admitted to the emergency department with aneurysmal SAH complicated by NPE-TCM, in which early endovascular coiling was successfully performed. Our case, characterized by a favorable outcome, further supports the evidence that early endovascular treatment should be preferred in this peculiar clinical scenario.
动脉瘤性蛛网膜下腔出血（SAH）可能与急性心肺并发症相关，如神经源性肺水肿（NPE）和应激性心肌病（TCM）。这些功能障碍似乎是由神经源性诱导的交感神经系统通过脑心连接过度刺激所致，并且常使低级别动脉瘤性SAH病情复杂化。在这种临床情况下，最佳治疗方式和干预时机尚未确定。早期血管内治疗似乎是这类特殊患者的合适治疗方法，在这类患者中，由于开颅手术风险增加，手术夹闭往往是禁忌的。在此，我们描述了一名因动脉瘤性SAH并发NPE-TCM而入住急诊科的女性病例，该患者成功接受了早期血管内栓塞治疗。我们的病例预后良好，进一步支持了在这种特殊临床情况下应优先选择早期血管内治疗的证据。
