Acute Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
BMJ Case Rep. 2022 Feb 28;15(2):e247522. doi: 10.1136/bcr-2021-247522.
Any insult to the central nervous system can lead to the rare occurrence of neurogenic pulmonary oedema (NPO). It is usually associated with significant neurological injury (eg, subarachnoid haemorrhage or traumatic brain injury) with a relatively rapid onset. As an exception to this observation, we report a middle-aged woman who developed NPO 72 hours after the onset of a subtle but evolving right middle cerebral artery infarction confirmed on CT. Aggressive use of diuretics and vasodilators, as is normally the case for cardiogenic pulmonary oedema, can compromise cerebral blood flow and the ischaemic penumbra. This case illustrates how the diagnostic and therapeutic challenges were successfully addressed with the aid of bedside ultrasonography and close haemodynamic monitoring to reverse the respiratory failure while protecting the brain.
任何对中枢神经系统的损伤都可能导致罕见的神经源性肺水肿（NPO）。它通常与明显的神经系统损伤（例如蛛网膜下腔出血或外伤性脑损伤）相关，且发病较为迅速。但在此观察之外，我们报告了一例中年女性，在 CT 证实右侧大脑中动脉梗死逐渐发展但症状轻微后 72 小时发生 NPO。通常用于治疗心源性肺水肿的利尿剂和血管扩张剂的积极使用可能会影响脑血流量和缺血半影区。该病例说明了如何借助床边超声和密切的血流动力学监测来解决诊断和治疗方面的挑战，从而在改善呼吸衰竭的同时保护大脑。
