NEUROGENIC IMPAIRMENT OF CARDIOPULMONARY FUNCTION IN ACUTE CEREBRAL-LESIONS

Incidence and clinical significance of cardiopulmonary complications o f acute cerebral lesions are still unclear. Neurogenic pulmonary edema (NPE) is characterized as an acute, protein-rich lung edema occurring shortly after cerebral lesions associated with an acute rise of intra cranial pressure. NPE is infrequently diagnosed, usually in associatio n with head trauma. Pathophysiological mechanisms include a rise of th e pulmonary vascular hydrostatic pressure either due to sympathetic in nervation with pulmonary vasoconstriction or increased left-atrial pre ssure following systemic arterial hypertension or an increase in pulmo nary capillary permeability. In contrast to NPE, cardiac complications are frequently observed, most consistently in patients with subaracho id hemorrhage. Typical ECG changes are repolarization abnormalities, s imilar to those observed in coronary heart disease, and cardiac arrhyt hmias. The CK-MB may be slightly elevated; echocardiographic findings show a depressed left-ventricular function. Pathological examination r eveals myofibrillar necrosis. Cardiac complications are explained with overactivity of the sympathetic innervation and high levels of circul ating catecholamines. For adequate treatment, close cardiac monitoring is required in all patients with acute cerebral lesions.