[A case of neurogenic pulmonary edema due to left internal carotid artery occlusion]

Rinsho Shinkeigaku. 2021 Jan 29;61(1):29-32. doi: 10.5692/clinicalneurol.cn-001491. Epub 2020 Dec 15.
[Article in Japanese]

Abstract

A 79-year-old woman developed consciousness disturbance, left eye deviation, right hemiplegia and aphasia with hypoxemia. Chest X-ray showed bilateral pulmonary edema. MRI revealed the left internal carotid artery occlusion and entire left middle cerebral artery infarct including insular cortex. We performed mechanical thrombectomy therapy and TICI3 recanalization was obtained. During operation, the respiratory condition deteriorated and the ventilator was started after mechanical thrombectomy therapy. Chest X-ray showed butterfly shadow, which indicated pulmonary edema. Pulmonary edema improved on the 2nd day of onset, and disappeared on the 3rd day. There was no heart diseases such as Takotsubo myocardiopathy, acute cardiac failure and cardiomyopathy on echocardiography and electrocardiography. Therefore, we diagnosed her as having neurogenic pulmonary edema due to cerebral infarction including insular cortex. We consider that left insular cortex infarction was a trigger of neurogenic pulmonary edema. If hypoxemia associated with infarction including the insular cortex, neurogenic pulmonary edema should be considered for medical treatment.

Keywords: acute; insular cortex; internal carotid artery occlusion; neurogenic pulmonary edema.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Arterial Occlusive Diseases / complications*
  • Arterial Occlusive Diseases / diagnostic imaging
  • Arterial Occlusive Diseases / therapy
  • Carotid Artery, Internal*
  • Cerebral Cortex / blood supply
  • Cerebral Revascularization / methods
  • Female
  • Humans
  • Infarction, Middle Cerebral Artery / complications*
  • Infarction, Middle Cerebral Artery / diagnostic imaging
  • Infarction, Middle Cerebral Artery / therapy
  • Magnetic Resonance Imaging
  • Pulmonary Edema / diagnostic imaging
  • Pulmonary Edema / etiology*
  • Pulmonary Edema / therapy
  • Thrombectomy / methods
  • Tomography, X-Ray Computed
  • Treatment Outcome