Key result
Early embolization of ruptured aneurysms and placement of spinal drainage resulted in rapid resolution of pulmonary edema and favorable clinical outcomes in four patients with severe SAH and NPE.
Why the study?
Does early embolization and spinal drainage improve outcomes in patients with ruptured aneurysmal subarachnoid hemorrhage and severe neurogenic pulmonary edema?
Case Report (n=4)
No
Does early embolization and spinal drainage improve outcomes in patients with ruptured aneurysmal subarachnoid hemorrhage and severe neurogenic pulmonary edema?
Early embolization of ruptured aneurysms combined with spinal drainage may be a satisfactory treatment option for severe subarachnoid hemorrhage complicated by neurogenic pulmonary edema.
May support early embolization and spinal drainage in severe SAH with NPE; hypothesis-generating and requires prospective validation before practice change.
SUMMARY: Four cases of ruptured aneurysmal subarachnoid hemorrhage (SAH) presented with severe neurogenic pulmonary edema (NPE). On admission, two patients were grade IV and two were grade V according to Hunt and Hess grading. All patients needed respiratory management with the assistance of a ventilator. Three of them underwent endovascular treatment for the ruptured aneurysms within three days from onset after ensuring hemodynamic stability. Immediately after the endovascular treatment, lumbar spinal drainage was inserted in all the patients. The pulmonary edema findings disappeared rapidly after the respiratory management. The results were good recovery in two, and moderate disability in two. We concluded that early embolization of ruptured aneurysm and placement of spinal drainage is a satisfactory option for severe SAH with NPE.
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Meguro et al. (2007) conducted a case report in Ruptured aneurysmal subarachnoid hemorrhage with neurogenic pulmonary edema (n=4). Early endovascular embolization and lumbar spinal drainage was evaluated on Clinical outcome and resolution of pulmonary edema. Early embolization of ruptured aneurysms and placement of spinal drainage resulted in rapid resolution of pulmonary edema and favorable clinical outcomes in four patients with severe SAH and NPE.
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