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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.55 no.2 São Paulo June 1997

http://dx.doi.org/10.1590/S0004-282X1997000200020 

Edema pulmonar neurogênico: relato de dois casos

 

Neurogenic pulmonary edema: report of two cases

 

 

Desanka DragosavacI; Antônio L. E. FalcãoII; Sebastião AraújoIII; Renato G. G. TerziIV

IUnidade de Tratamento Intensivo, Hospital das Clínicas Universidade Estadual de Campinas (UTI-HC-UNICAMP): Médica intensivista, Doutora em tratamento intensivo
IIUnidade de Tratamento Intensivo, Hospital das Clínicas Universidade Estadual de Campinas (UTI-HC-UNICAMP): Médico neurologista e intensivista, Doutor em Neurociências

IIIUnidade de Tratamento Intensivo, Hospital das Clínicas Universidade Estadual de Campinas (UTI-HC-UNICAMP): Diretor da UTI, HC, UNICAMP, Doutor em Clínica Cirúrgica
IVProfessor de Cirurgia e Metabologia Cirúrgica, Coordenador da UTI-HC-UNICAMP

 

 


RESUMO

O edema pulmonar neurogênico é rara e grave complicação de pacientes com traumatismo craniencefálico (TCE). Pode ocorrer também em outras patologias do sistema nervoso central, tais como acidentes vasculares cerebrais (AVC), tumores ou após crises epilépticas, entre outras. Foram avaliados 36 casos com TCE grave e quatro pacientes com AVC, internados na UTI geral, no período de janeiro a setembro 1995. Nesse intervalo de tempo foram diagnosticados dois casos de edema pulmonar neurogênico, um ocorrendo em paciente com TCE grave e outro em paciente com AVC hemorrágico. O diagnóstico foi estabelecido pelo rápido desenvolvimento de edema pulmonar, com hipoxemia grave, queda da complacência pulmonar e infiltrados difusos bilaterais sem história prévia de aspiração traqueal ou outro fator de risco para o desenvolvimento de síndrome de angústia respiratória aguda. No primeiro paciente com trauma craniencefálico, o edema neurogênico foi diagnosticado na internação, uma hora após o trauma, com concomitante reação inflamatória grave e boa evolução em três dias. O outro caso, com AVC hemorrágico, desenvolveu edema neurogênico no quarto dia após drenagem de hematoma intraparenquimatoso, evoluindo para o óbito.

Palavras-chave: edema pulmonar neurogênico, trauma craniencefálico, acidente vascular cerebral.


ABSTRACT

Neurogenic pulmonary edema is a rare and serious complication in patients with head injury. It also may develop after a variety of cerebral insults such as subarachnoid hemorrhage, brain tumors and after epileptic seizures. Thirty six patients with severe head injury and four patients with cerebrovascular insults treated in Intensive Care Unit of HC-UNICAMP from January to September 1995 were evaluated. In this period there were two patients with neurogenic pulmonary edema, one with head injury and other with intracerebral hemorrhage. Diagnosis was made by rapid onset of pulmonary edema, severe hypoxemia, decrease of pulmonary complacence and diffuse pulmonary infiltrations, without previous history of tracheal aspiration or any other risk factor for developement of adult respiratory distress syndrom. In the first case, with severe head trauma, neurogenic pulmonary edema was diagnosed at admission one hour after trauma, associated with severe systemic inflammatory reaction, and good outcome in three days. The second case, with hemorragic vascular insult, developed neurogenic pulmonary edema the fourth day after drenage of intracerebral hematom and died.

Key words: neurogenic pulmonary edema, head injury, cerebrovascular insult.


 

 

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Aceite: 31-janeiro-1997.

 

 

Dra. Desanka Dragosavac - Rua Lopes Trovão 336 apto 112 - 13090-090 Campinas, SP - Brasil.

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