中枢性肺水腫を合併した破裂脳動脈瘤に対する急性期手術の経験

概要

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Two cases of ruptured intracranial aneurysm associated with neurogenic pulmonary edema are described. One patient, a 53-year-old female, was Hunt and Kosnik grade 4 on admission and was expressing pinkish, foamy sputum. A ruptured aneurysm in the anterior communicating artery was clipped 3 hours later. The second patient, a 55-year-old female, was also grade 4 on admission and she, too, exhibited signs of pulmonary edema. A ruptured aneurysm at the junction of the right internal carotid-posterior communicating arteries was clipped 4 hours later. In both cases, intra- and postoperative respiratory maintenance with positive end-expiratory pressure was successfully carried out. Both patients were discharged without major neurological deficits. The optimal timing of surgery for ruptured cerebral aneurysms associated with neurogenic pulmonary edema has not been clearly determined. In these two cases, very early surgery combined with aggressive management of the pulmonary edema was successful. The importance of early diagnosis and treatment of pulmonary edema is stressed, and the timing of surgery after subarachnoid hemorrhage is discussed.
日本脳神経外科学会の論文
1988-11-15