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Neurogenic pulmonary edema and Takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage

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Abstract

Purpose

Neurogenic pulmonary edema (NPE) combined with Takotsubo cardiomyopathy (TCM) is a rare condition associated with aneurysmal subarachnoid hemorrhage (aSAH). Although several mechanisms have been proposed, the pathophysiology and management strategies are not yet fully established. We aimed to determine the radiological and clinical outcomes of patients with NPE and with TCM after aSAH to propose management strategies.

Methods

We analyzed the data of 564 patients with aSAH recorded at a single medical center from February 2015 to July 2022. This study retrospectively investigated the incidence and demographics of SAH combined with both NPE and TCM and the clinical outcomes of the patients. Correlating factors, independently associated with NPE-TCM, were also investigated.

Results

During the 7 years, 11 (2.0%) of 564 patients had NPE complicated with TCM after aSAH. Seven of 11 (63.6%) patients had poor-grade SAH (Hunt–Hess Grade 4 to 5). Three of 11 patients had a posterior circulation in the NPE-TCM group. The most prevalent treatment option was endovascular coil embolization, except for one case of clip. Long-term outcomes were favorable in 6 of 11 patients, and there was one case of mortality. Age, troponin I level, and alveolar-arterial oxygen gradient were correlating factors of NPE-TCM.

Conclusion

Although NPE-TCM represents a rare complication associated with aSAH, achieving active resolution of underlying neurological causes through early and appropriate treatment may contribute to a favorable prognosis. Considering the limited incidence of SAH complicated with NPE-TCM, a multi-center study may be needed.

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Data Availability

According to the medical laws in South Korea, the data used in this study cannot be freely disclosed. However, pseudonymized datasets can be shared after obtaining formal approval for the scientific research plan and data management plan from the Ajou University Hospital’s Institutional Review Board (IRB).

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Authors and Affiliations

  1. Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea

    Eui-Hyun Hwang, Ja Ho Koo, Yeon Hu Lee, Ji Hye Song & Yong Cheol Lim

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  1. Eui-Hyun Hwang
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  2. Ja Ho Koo
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  3. Yeon Hu Lee
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  4. Ji Hye Song
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Eui-Hyun Hwang. The first draft of the manuscript was written by Eui-Hyun Hwang, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Conceptualization: Eui-Hyun Hwang, Yeon Hu Lee, Yong Cheol Lim.

Methodology: Eui-Hyun Hwang, Ja Ho Koo.

Formal analysis and investigation: Eui-Hyun Hwang.

Writing – original draft preparation: Eui-Hyun Hwang.

Writing—review and editing: Eui-Hyun Hwang. Ji Hye Song, Yong Cheol Lim.

Funding acquisition: none.

Resources: Eui-Hyun Hwang.

Supervision: Ji Hye Song, Yong Cheol Lim.

Corresponding author

Correspondence to Yong Cheol Lim.

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Ethics approval

This study was approved by the Institutional Review Board Ajou University Hospital (AJOUIRB-DB-2022–384) and conducted in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare no competing interests.

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Hwang, EH., Koo, J.H., Lee, Y.H. et al. Neurogenic pulmonary edema and Takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage. Acta Neurochir 165, 3677–3684 (2023). https://doi.org/10.1007/s00701-023-05824-y

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  • DOI: https://doi.org/10.1007/s00701-023-05824-y

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