[Neurogenic pulmonary edema after subarachnoid hemorrhage]

We report on a 54-year-old previously healthy man admitted to the emergency room with massive pulmonary edema and unstable cardiovascular condition. Coronary heart disease was ruled out angiographically. The pressures in the pulmonary circulation were within normal limits and no signs of congestive heart failure were found. A computed tomographic scan of the head was suggestive for subarachnoid hemorrhage. The lumbar puncture yielded bloody cerebrospinal fluid confirming the diagnosis. A digital subtraction angiogram revealed an aneurysm of the anterior communicating artery. The patient succumbed to a recurrent hemorrhage. The aneurysm was verified on postmortem examination. In pulmonary edema of unknown origin the possibility of neurogenic pulmonary edema should be considered. Etiology, pathomechanism, and therapy of neurogenic pulmonary edema are discussed.