Neurogenic pulmonary oedema misdiagnosed as acute myocardial infarction in a comatose patient

ABSTRACT

<p><b>INTRODUCTION</b>We report a case of neurogenic pulmonary oedema (NPO) following massive left cerebral infarct, which was initially misdiagnosed as acute myocardial infarction (AMI).</p><p><b>CLINICAL PICTURE</b>This 52-year-old man presented with acute loss of consciousness with normal brain computed tomography (CT). He was treated as non-ST-elevation AMI complicated with pulmonary oedema based on findings of chest radiograph (bilateral pulmonary oedema), electrocardiogram (marked ST-T changes in leads V3 to V6), and cardiac enzymes [elevated creatinine kinase (CK) and CK-MB]. However, coronary angiogram and serial cardiac enzymes were inconclusive. Anisocoria developed after admission and a repeat brain CT was evident for large left cerebral infarct.</p><p><b>TREATMENT</b>Decompressive craniectomy was carried out.</p><p><b>OUTCOME</b>Mortality.</p><p><b>CONCLUSIONS</b>The diagnosis of NPO can be challenging when it occurs without abnormal findings on preliminary brain CT. It can be mistaken for cardiogenic pulmonary oedema secondary to AMI.</p>