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The neurogenic pulmonary edema is a rare clinical situation caused by an imbalance characterized by an excessive sympathetic outflow. It is observed mostly in young patients, is associated with brain or spinal cord haemorrhage, trauma, tumours or infections and is usually fatal. A case of neurogenic pulmonary edema in a 27-year-old woman is presented, caused by a cerebellar haemorrhage due to a vermian and paravermian arteriovenous malformation rupture. The vermian and hemispheric haemorrhage injuring the sub-lobule IX-b of the uvula induced a disruption of both carotid baroreceptor and chemoreceptor reflexes control mechanisms. Medical treatment with controlled ventilation, PEEP, diuretics and morphine reverted the pulmonary edema. After surgical treatment of the haemorrhage and cerebellar AVM the patient recovered to an almost normal social and professional life. The cerebellar lesion induced a temporary vermian sub lobule IX-b dysfunction that was responsible for the sympathetic storm that evoked the neurogenic pulmonary edema.

The purpose of this study was to investigate the effects of electrical and chemical stimulation of the sub-lobule IX-b of the cerebellar uvula on the cardiorespiratory responses evoked on stimulation of the carotid chemoreceptors in the anaesthetised and paralysed rabbit. Recordings of arterial blood pressure, ECG, heart rate and phrenic nerve activity were evaluated. Sub-lobule IX-b was activated electrically (1 ms, 20 microA, 100 Hz, 4-s train) and stimulated chemically with sodium glutamate microinjections (2 mM, pH=7.4 +/- 0.1) using bipolar concentric or multibarrelled microelectrodes. Carotid body chemoreflexes were evoked by the retrograde injection of sodium cyanide (0.1%, 0.1 ml) into the blood supply of the carotid body through a cannula inserted in the external carotid artery. The interaction of uvula stimulation and the carotid chemoreceptor reflex was studied by following the chemoreceptor stimulus with a stimulus to the uvula. Electrical and chemical stimulation of the uvula evoked a characteristic bradycardia and a depressor response together with a decrease in phrenic nerve activity. Carotid body stimulation evoked a decrease in heart rate accompanied by an increase of both arterial blood pressure and phrenic nerve activity. However, simultaneous delivery of the two stimuli resulted in a depressor response together with a decrease of phrenic nerve activity and an increased bradycardia. These data suggest that stimulation of the cerebellar uvula exerts an inhibitory control of the chemoreflex efficacy as far as respiratory activity and blood pressure is concerned.

The purpose of this study was to investigate the effects of electrical and chemical stimulation of the sub-lobule IX-b of the cerebellar uvula on the cardiorespiratory responses evoked on stimulation of the carotid chemoreceptors in the anaesthetised and paralysed rabbit. Recordings of arterial blood pressure, ECG, heart rate and phrenic nerve activity were evaluated. Sub-lobule IX-b was activated electrically (1 ms, 20 μA, 100 Hz, 4-s train) and stimulated chemically with sodium glutamate microinjections (2 mM, pH=7.4±0.1) using bipolar concentric or multibarrelled microelectrodes. Carotid body chemoreflexes were evoked by the retrograde injection of sodium cyanide (0.1%, 0.1 ml) into the blood supply of the carotid body through a cannula inserted in the external carotid artery. The interaction of uvula stimulation and the carotid chemoreceptor reflex was studied by following the chemoreceptor stimulus with a stimulus to the uvula. Electrical and chemical stimulation of the uvula evoked a characteristic bradycardia and a depressor response together with a decrease in phrenic nerve activity. Carotid body stimulation evoked a decrease in heart rate accompanied by an increase of both arterial blood pressure and phrenic nerve activity. However, simultaneous delivery of the two stimuli resulted in a depressor response together with a decrease of phrenic nerve activity and an increased bradycardia. These data suggest that stimulation of the cerebellar uvula exerts an inhibitory control of the chemoreflex efficacy as far as respiratory activity and blood pressure is concerned. [Copyright &y& Elsevier]