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63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

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Subarachnoid hemorrhage complicated with neurogenic pulmonary edema and takotsubo cardiomyopathy

Meeting Abstract

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  • J. Inamasu - Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan; Department of Neurosurgery, Fujita Health University School of Medicine, Toyoake, Japan
  • M. Nakatsukasa - Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
  • Y. Kato - Department of Neurosurgery, Fujita Health University School of Medicine, Toyoake, Japan
  • Y. Hiros - Department of Neurosurgery, Fujita Health University School of Medicine, Toyoake, Japan

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP 069

doi: 10.3205/12dgnc456, urn:nbn:de:0183-12dgnc4564

Published: June 4, 2012

© 2012 Inamasu et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Patients with poor-grade subarachnoid hemorrhage (SAH) are occasionally complicated with acute cardiopulmonary dysfunctions, particularly neurogenic pulmonary edema (NPE) and takotsubo cardiomyopathy (TCM). To investigate the incidence, demographics, and outcomes of SAH patients complicated with NPE and TCM (NPE-TCM) is the objective of this study.

Methods: SAH patients presenting with clinical and radiographic signs of NPE underwent transthoracic ultrasound (TUS) prospectively. Those complicated with NPE-TCM were identified from institutional database, and data was reviewed retrospectively. Whether SAH severity and aneurysm location influenced the incidence of NPE-TCM was also investigated.

Results: Among 234 SAH patients treated in 6-year-period, 16 (7%) presented with NPE. TUS revealed that 14 of them (88%) were complicated with TCM as well. All of the 14 patients with NPE-TCM sustained poor-grade SAH (Grade IV and V by the WFNS scale). Poor-grade SAH patients due to ruptured posterior circulation aneurysm showed significantly higher incidence of NPE-TCM than those with ruptured anterior circulation aneurysm (38% vs. 8%, p=0.004). Six of the 14 patients (43%) complicated with NPE-TCM were unable to undergo treatment for the ruptured aneurysm because of poor systemic condition. The remaining 8 patients were treated either surgically or endovascularly. Long-term outcomes were favorable in 5 (36%). Grade IV patients had more favorable outcomes than Grade V patients (80% vs. 11%, p=0.02).

Conclusions: TCM develops frequently in SAH patients presenting with NPE. Those with ruptured posterior circulation aneurysm have elevated risk of developing NPE-TCM. Although endovascular treatment may be preferable, optimal treatment modality remains to be evaluated.