Authors
Lisheng Wu, Ying Sun
Published in
Zhonghua wei zhong bing ji jiu yi xue. Volume 38. Issue 5. Pages 569-574.
Abstract
Due to their unique pathophysiological states, neurocritical care patients are at a significantly increased risk of acute pulmonary embolism. Typical symptoms are frequently masked by neurological deficits, resulting in delayed diagnosis. Furthermore, clinical management is highly challenging owing to the concurrent high risk of intracranial hemorrhage. On February 26, 2025, Linyi People's Hospital admitted a 67-year-old male patient who developed neurogenic stress cardiomyopathy (NSC) and acute submassive pulmonary embolism following surgery for a ruptured aneurysm. The patient presented with a chief complaint of "sudden onset headache accompanied by loss of consciousness for 6 hours." Physical examination revealed a deep coma with a Glasgow Coma Scale (GCS) score of 3 (E1V1M1), a Hunt-Hess grade of IV, and a modified Fisher grade of 4. Both pupils were 2.5 mm in diameter and reactive to light, and nuchal rigidity was positive. Cerebral computed tomography angiography (CTA) demonstrated an anterior communicating artery aneurysm, subarachnoid hemorrhage, and extensive intraventricular hemorrhage. Based on the medical history, clinical manifestations, and imaging findings, the patient was diagnosed with a ruptured anterior communicating artery aneurysm complicated by subarachnoid hemorrhage and secondary intraventricular hemorrhage. Emergent stent-assisted coil embolization of the anterior communicating artery aneurysm, cerebral angiography, and bilateral external ventricular drainage were performed under general anesthesia. Postoperatively, the patient was transferred to the neurosurgical intensive care unit (ICU) with endotracheal intubation and high-dose vasoactive support. Upon admission, concurrent NSC and severe hemodynamic instability were confirmed via bedside ultrasound and laboratory tests. Following one week of comprehensive management, including the control of inappropriate stress responses, clearance of bloody cerebrospinal fluid, management of intracranial hypertension, and optimization of vasoactive agents, the patient's hemodynamics stabilized, and vasoactive drugs were successfully discontinued. However, during the second postoperative week, the patient's condition deteriorated. Bedside echocardiography detected characteristic signs of right ventricular overload [right ventricle-to-left ventricle diameter ratio (RV/LV ratio) >1, "Notch sign," and "McConnell's sign"] that were highly suggestive of acute pulmonary embolism. This was immediately confirmed by computed tomography pulmonary angiography (CTPA). Following thorough deliberation by a multidisciplinary team (MDT) and careful balancing of the hemorrhagic and thrombotic risks, an individualized anticoagulation regimen was implemented. After three weeks of intensive intervention, the patient's condition stabilized, and he was successfully transferred out of the neurosurgical intensive care unit. At the 6-month postoperative follow-up, the patient's modified Rankin Scale (mRS) score was 3. Neurocritical care patients represent a high-risk population for acute pulmonary embolism. Bedside ultrasound facilitates the early identification of pulmonary embolism in these high-risk individuals. Utilizing an MDT to formulate individualized clinical intervention strategies is crucial for balancing the management of intermediate-to-high-risk pulmonary embolism with the risk of intracranial hemorrhage.
PMID:
42427331
Bibliographic data and abstract were imported from PubMed on 10 Jul 2026.
Read full publication at:
Please sign in
to see all details.
Advertisement
Stats
- Recommendations n/a n/a positive of 0 vote(s)
- Views 5
- Comments 0