Neurogenic pulmonary edema (NPE) is defined as an acute pulmonary edema occurring
after a central neurologic insult. It is associated with head injury and seizures, intracranial
hemorrhage and stroke are among the other causes. Pathologies increasing intracranial
pressure may cause excessive sympathetic discharge and lead to pulmonary vascular
pressure changes and transcapillary fluid leakage. Hereby we present an acute respiratory
failure in a 50-year old woman with subarachnoid hemorrhage (SAH) due to aneurysmal
rupture of anterior communicating artery. The patient had a history of bronchial asthma
and respiratory failure was thought to have occurred by radiocontrast induced airway
hyper-responsiveness during cerebral angiography. No response to bronchodilator
therapy, pinkish foamy sputum from the trachea, diffusely dense infiltrates on both lungs
demonstrated by chest X-ray, normal echocardiography, and negative tracheal culture
disproving pneumonia were among the factors leading to the diagnosis of NPE. Consistent
with the diagnosis, the patient rapidly improved with mechanical ventilation and
subsequent removal of the intracranial hematoma. After evaluation of the clinical course of
our case, we recommend that NPE should be considered in the differential diagnosis of
acute respiratory failure accompanying SAH.