Neurogenic Pulmonary Edema in Patients with Aneurysmal Subarachnoid Hemorrhage

Aneurogenic pulmonary edema(NPE) following an aneurysmal subarachnoid hemorrhage(SAH) is a rare but devastating complication. The authors analyzed the clinical characteristics, therapeutic problems and management results from our cases in order to throughly evaluate for future therapeutic guide for such patients. There were seven patients diagnosed as NPE out of 546 patients who were admitted within one day following a SAH(1.3%) during the past 13 years. They were relatively young(average 51.3 years), had poor clinical grades on admission and had large amount of SAH. Hypotension and hypoxia on admission were also characteristics. Good results were obtained in 4 of the 7 patients by rapid correction of hypoxia and hypotension with intubation, mechanical ventilation and with positive end-expiratory pressure, diuretics and hypertensive drugs. We conclude that NPE following SAH may be triggered by an acute rise in intracranial pressure followed by a simultaneous decrease of the function of the heart and lungs. Although the patients had shown fulminant clinical state on admission, we recommend aggressive management of these patients because some of these patients can recover without neurological deficits by an aggressive treatment.

Spontaneous Spinal Epidural Hematoma: Case Report

The case of 17-year-old boy is presented, in whom back pain progressed to paraplegia. A spinal epidural hematoma was removed at surgery with complete recovery. No traumatic or febrile episode was obtainable. The importance of early diagnosis and early spinal decompression is stressed.

Medulloblastoma with Extracranial Metastates: Case Report

Intracranial tumor with extracranial metastasis has been seldom reported. A 28 year-old-male was admitted to Presbyterian Hospital in Daegu on May 9, 1977. Who was diagnosed to have a medulloblastoma in the right cerebellar hemisphere with metastases to the right axillary lymphnode and head of pancreas by pathological reports. In generally medulloblastoma with extracranial metastasis occurs very rarely in the cerebellar hemisphere, and especially in adulthood. Distant metastasis of the intracranial tumor is discussed with review of the literatures.