Neurogenic Pulmonary Edema Caused by Subarachnoid Hemorrhage: A Case Report

Neurogenic pulmonary edema is a serious and life-threatening complication caused by central nervous system diseases, excluding cardiogenic pulmonary edema, other causes of pulmonary edema, lung injury, etc. The lack of specific diagnostic criteria for NPE and the lack of awareness among clinicians often lead to underdiagnosis and misdiagnosis. The disease progresses rapidly with poor prognosis and high mortality [1]. In this paper, we report a patient with a ruptured right middle cerebral artery aneurysm causing subarachnoid hemorrhage, who developed neurogenic pulmonary edema and underwent elective aneurysm clamping under general anesthesia. The relevant perioperative management is reported as follows, and the anesthesia management of patients with neurogenic pulmonary edema is analyzed in the context of the relevant literature.

Extracranial Dural Arteriovenous Fistula as a Cause of Mastoid Mass: A Case Report

Introduction: Dural arteriovenous fistulas account for 10 to 15% of intracranial arteriovenous malformations. They are defined as malformations to short-circuits between dural and extracranial arteries with dural venous sinuses. Its presentation is in frequent and its management is a challenge in low- and middle-income countries where there are difficulties in accessing high quality technological tools. Case: We present the case of an unusual dural arteriovenous fistula involving the mastoid region and draining into the external jugular vein and through emissary veins into the superior longitudinal sinus, which was treated transarterially. Conclusion: Endovascular management of intracranial dural arteriovenous fistulas can be a challenge. Endovascular treatment includes a transarterial or transvenous approach from the femoral artery or vein. There is little evidence on this subject, so it is necessary to carry out more studies to determine risk factors, intervention effects and medium- and long-term outcomes.

Ruptured Abdominal Aortic Aneurysm After Successful Transcatheter Aortic Valve Replacement- A Case Report and Review of Management

Background: Transcatheter aortic valve replacement is an important procedure with the aging US population presenting with more aortic stenosis and as many as 10 % of these patients presenting with an abdominal aortic aneurysm at the time of screening. This procedure has also been shown to be as safe as open aortic valve replacement with lower risks of death, stroke, and rehospitalization. Case Report: A 91-year-old female presents approximately one month after transcatheter aortic valve with an acute retroperitoneal rupture of a known abdominal aortic aneurysm. The patient was taken for an emergent endovascular aortic aneurysm repair and became suddenly unresponsive and apneic prior to any anesthetic drug administration, the patient was intubated, and rapid transfusion was started. The procedure was completed successfully with immediate improvement in the patient’s vitals after deployment of the stent. The patient was recovering well, but five days later had a sudden pulseless electrical activity arrest and after appropriate but unsuccessful advanced cardiac life support was declared deceased. Conclusion: While not standard of care, a simultaneous endovascular aneurysm repair during transcatheter aortic valve repair in select patients seems to be a safe procedure without increase in complications from either procedure completed separately. The aim of this manuscript is to review the recent success of simultaneous repair and to illustrate that this newer method may improve outcomes.