Acute Neurogenic Pulmonary Edema Associate with Hypothalamic Infarction due to Top-of-Basilar Syndrome in an Adolescent
Neurogenic pulmonary edema is one of the critical complications associated with devastating stroke. In most case, primary neurogenic insult is reported as subarachnoid hemorrhage, and ischemic stroke is rarely reported as a primary cause. Herein we report a 17-year old female who had acute pulmonary edema associated with hypothalamic infarction due to top-of-basilar syndrome. Acute infarction was observed at bilateral thalamus, hypothalamus, and right hemisphere of cerebellum. Just after admission, she developed acute respiratory failure due to bilateral pulmonary edema. Pulmonary edema was improved under positive end-expiratory pressure ventilation in the next 3 days. She gradually recovered her consciousness over 1 month with mild disturbance of short-term memory. Recently, the novel hypothesis of localized insult to ‘neurogenic pulmonary edema trigger zones’ has been proposed. This case supports the hypothesis that hypothalamus can be one of the trigger zones.