• Vol. 36 No. 8, 684–686
  • 15 August 2007

Neurogenic Pulmonary Oedema Misdiagnosed as Acute Myocardial Infarction in a Comatose Patient

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ABSTRACT

Introduction: We report a case of neurogenic pulmonary oedema (NPO) following massive left cerebral infarct, which was initially misdiagnosed as acute myocardial infarction (AMI). Clinical Picture: 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. Treatment: Decompressive craniectomy was carried out. Outcome: Mortality. Conclusions: 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.


Neurogenic pulmonary oedema (NPO) is a well recognised complication of subarachnoid haemorrhage (SAH) and severe traumatic brain injuries (TBI).1 The incidence of NPO was reported to be 6% in a series of 457 patients with SAH.2 However, the diagnosis of NPO can be challenging when it occurs without abnormal findings on preliminary brain computed tomography (CT). It can be mistaken for acute heart failure, pneumonia, or acute respiratory distress syndrome (ARDS). We report a case of NPO following massive left cerebral infarct which was initially misdiagnosed as cardiogenic pulmonary oedema due to acute myocardial infarction (AMI).

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