Edema pulmonar neurogênico: relato de dois casos

Dragosavac, Desanka; Falcão, Antônio L. E.; Araújo, Sebastião; Terzi, Renato G. G.

doi:10.1590/S0004-282X1997000200020

Resumos

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.

edema pulmonar neurogênico; trauma craniencefálico; acidente vascular cerebral

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.

neurogenic pulmonary edema; head injury; cerebrovascular insult

Edema pulmonar neurogênico: relato de dois casos

Neurogenic pulmonary edema: report of two cases

Desanka Dragosavac^I; Antônio L. E. Falcão^II; Sebastião Araújo^III; Renato G. G. Terzi^IV

^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.

Texto completo disponível apenas em PDF.

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Aceite: 31-janeiro-1997.

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

1. Bembridge M, Madej TH. Neurogenic pulmonary oedema. Anaesthesia 1985;40:202-204.
2. Brande N, Ludgrove T. Neurogenic pulmonary oedema precipitated by induction of anaesthesia. Br J Anaesth 1989;62:101-103.
3. Brito JCF, Diniz MCA, Rosas RR, Silva JAG. Edema pulmonar agudo neurogênico: relato de caso. Arq Neuropsiquiatr 1995;53:288-293.
4. Brown RH, Beyerl BD, Iseke R, Lavy MH. Medulla oblongata oedema associated with neurogenic pulmonary oedema: case report. J Neurosurg 1986;64:494-500.
5. Casey WF. Neurogenic pulmonary oedema. Anaesthesia 1983;38:985-988.
6. Dettbarn CL, Davidson LJ. Pulmonary complications in the patient with acute head injury: neurogenic pulmonary oedema. Heart Lung 1989;18:583-589.
7. Ell SR. Neurogenic pulmonary oedema: a review of the literature and a perspective. Inv Radiol 1991 ;26:499-506.
8. Falcão ALE, Dantas VF, Sardinha LC, Quagliato EAB, Dragosavac D, Araújo S, Terzi RGG. Highlighting intracranial pressure monitoring in patients with severe acute brain trauma. Arq Neuropsiquiatr 1995;53:390-394.
9. Falcão ALE, Dantas VF, Saraiva JFK, Sardinha LC, Araújo S, Terzi RGG. Bedside ICP monitoring in head trauma patients by using a simple, safe and low cost metodology (Abstr). Clin Int Care 1992;3(Suppl): 112.
10. Graf CJ, Rossi NP. Pulmonary oedema and central nervous system:a clinico-pathological study. Surg Neurol 1975;4:319-325.
11. Kauffman HH, Tíniberlake G, Voelker J, Glenn PT. Medical complications of head injury. Med Clin North Am Jan 1993:70:43-60.
12. Knudsen F, Jensen HP, Peterson PL. Neurogenic pulmonary edema: treatment with dobutamine. Neurosurgery 1991 ;29:269-270.
13. Li C, Getter WB. Acute pulmonary edema induced by overdosage of phenothiazines.Chest 1992; 101:102-104.
14. Malik AB. Mechanisms of neurogenic pulmonary edema. Circ Res 1985;57:1 -18.
15. Melone E, Bonnet F, Lepreslo E, Fevrier MJ, Djindjian M, Francois Y, Gray F, Debras C. Altered capillary permeability in neurogenic pulmonary edema. Int Care Med 1985; 11:323-325.
16. Murphy PG, Jackson R, Kirollos R, Gibson JS, Chennells P Adult respiratory distress syndrome after attenuated strangulation. Br J Anasth 1993;70:583-586.
17. Pender ES, Pollack CV. Neurogenic pulmonary edema: case reports and review. J Em Med 1992; 10:45-51.
18. Pollack V, Pollack ES. Neurogenic pulmonary edema. J Emerg Med 1993; 11:207-210.
19. Simmons RL, Martin AM, Heisterkamp CA, DucherTB. Respiratory insufficiency in combat casualties: II Pulmonary edema following head injury. Ann Surg 1969; 170:39-41.
20. Simon RP Neurogenic pulmonary edema. Neurol Clin 1993;11.309-323.
21. Simon RP. Medullary lesion inducing pulmonary edema: a magnetic resonance imaging study. Ann Neurol 1991 ;30:727-730.
22. Toucho H, Kavasawa J, Sishido H, Yamada K, Yamazaki Y. Neurogenic pulmonary edema in the acute stage of hemorrhagic cerebrovascular disease. Neurosurgery 1989;25:762-768.
23. Wauchob TD, Brooks RJ, Harrison KM. Neurogenic pulmonary oedema. Anaesthesia 1984,39:529-534.
24. Wright RS. Feuerman T, Brown J. Neurogenic pulmonary edema after trigeminal nerve blockade. Chest 1989,96:436-438.

Datas de Publicação

Publicação nesta coleção
10 Nov 2010
Data do Fascículo
Jun 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Bembridge M, Madej TH. Neurogenic pulmonary oedema. Anaesthesia 1985;40:202-204.

[2] 2. Brande N, Ludgrove T. Neurogenic pulmonary oedema precipitated by induction of anaesthesia. Br J Anaesth 1989;62:101-103.

[3] 3. Brito JCF, Diniz MCA, Rosas RR, Silva JAG. Edema pulmonar agudo neurogênico: relato de caso. Arq Neuropsiquiatr 1995;53:288-293.

[4] 4. Brown RH, Beyerl BD, Iseke R, Lavy MH. Medulla oblongata oedema associated with neurogenic pulmonary oedema: case report. J Neurosurg 1986;64:494-500.

[5] 5. Casey WF. Neurogenic pulmonary oedema. Anaesthesia 1983;38:985-988.

[6] 6. Dettbarn CL, Davidson LJ. Pulmonary complications in the patient with acute head injury: neurogenic pulmonary oedema. Heart Lung 1989;18:583-589.

[7] 7. Ell SR. Neurogenic pulmonary oedema: a review of the literature and a perspective. Inv Radiol 1991 ;26:499-506.

[8] 8. Falcão ALE, Dantas VF, Sardinha LC, Quagliato EAB, Dragosavac D, Araújo S, Terzi RGG. Highlighting intracranial pressure monitoring in patients with severe acute brain trauma. Arq Neuropsiquiatr 1995;53:390-394.

[9] 9. Falcão ALE, Dantas VF, Saraiva JFK, Sardinha LC, Araújo S, Terzi RGG. Bedside ICP monitoring in head trauma patients by using a simple, safe and low cost metodology (Abstr). Clin Int Care 1992;3(Suppl): 112.

[10] 10. Graf CJ, Rossi NP. Pulmonary oedema and central nervous system:a clinico-pathological study. Surg Neurol 1975;4:319-325.

[11] 11. Kauffman HH, Tíniberlake G, Voelker J, Glenn PT. Medical complications of head injury. Med Clin North Am Jan 1993:70:43-60.

[12] 12. Knudsen F, Jensen HP, Peterson PL. Neurogenic pulmonary edema: treatment with dobutamine. Neurosurgery 1991 ;29:269-270.

[13] 13. Li C, Getter WB. Acute pulmonary edema induced by overdosage of phenothiazines.Chest 1992; 101:102-104.

[14] 14. Malik AB. Mechanisms of neurogenic pulmonary edema. Circ Res 1985;57:1 -18.

[15] 15. Melone E, Bonnet F, Lepreslo E, Fevrier MJ, Djindjian M, Francois Y, Gray F, Debras C. Altered capillary permeability in neurogenic pulmonary edema. Int Care Med 1985; 11:323-325.

[16] 16. Murphy PG, Jackson R, Kirollos R, Gibson JS, Chennells P Adult respiratory distress syndrome after attenuated strangulation. Br J Anasth 1993;70:583-586.

[17] 17. Pender ES, Pollack CV. Neurogenic pulmonary edema: case reports and review. J Em Med 1992; 10:45-51.

[18] 18. Pollack V, Pollack ES. Neurogenic pulmonary edema. J Emerg Med 1993; 11:207-210.

[19] 19. Simmons RL, Martin AM, Heisterkamp CA, DucherTB. Respiratory insufficiency in combat casualties: II Pulmonary edema following head injury. Ann Surg 1969; 170:39-41.

[20] 20. Simon RP Neurogenic pulmonary edema. Neurol Clin 1993;11.309-323.

[21] 21. Simon RP. Medullary lesion inducing pulmonary edema: a magnetic resonance imaging study. Ann Neurol 1991 ;30:727-730.

[22] 22. Toucho H, Kavasawa J, Sishido H, Yamada K, Yamazaki Y. Neurogenic pulmonary edema in the acute stage of hemorrhagic cerebrovascular disease. Neurosurgery 1989;25:762-768.

[23] 23. Wauchob TD, Brooks RJ, Harrison KM. Neurogenic pulmonary oedema. Anaesthesia 1984,39:529-534.

[24] 24. Wright RS. Feuerman T, Brown J. Neurogenic pulmonary edema after trigeminal nerve blockade. Chest 1989,96:436-438.