{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T14:01:45Z","timestamp":1775570505335,"version":"3.50.1"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Neurogenic pulmonary edema (NPE) is defined as an acute respiratory distress syndrome triggered by severe sympathetic discharge from acute compromise in the central nervous system. Due to the absence of specific diagnostic indicators, NPE is challenging to rapidly identify and accurately diagnose. We report a case of NPE coupled with myocardial damage following tenecteplase thrombolysis for acute ischemic stroke, explore the differential diagnosis of pulmonary edema after thrombolysis, and analyze multiple peripheral organ damage following ischemic stroke. A 61-year-old Chinese male presented with acute-onset aphasia and left-sided hemiparesis persisting for 3.25\u2005h. Approximately one hour after tenecteplase thrombolysis, the patient developed acute respiratory distress. Arterial blood gas analysis demonstrated PaO\u2082 of 54\u2005mmHg and PaCO\u2082 of 62\u2005mmHg. Chest CT revealed patchy opacities with indistinct margins in the dorsal lung regions. Laboratory investigations revealed elevated levels of creatine kinase, creatine kinase-MB, B-type natriuretic peptide, and high-sensitivity troponin I. Echocardiogram demonstrated reduced left ventricular systolic function. The electrocardiogram exhibited ST-T segment abnormalities. Abnormal laboratory parameters indicative of hepatic and renal dysfunction were observed on admission day 2. Based on the clinical diagnosis of NPE, therapeutic interventions were initiated, including intravenous administration of furosemide, methylprednisolone sodium succinate, sodium nitroprusside, and piperacillin sodium\/tazobactam sodium. The patient's clinical manifestations, laboratory parameters, and imaging findings improved significantly. Additionally, Takotsubo syndrome was considered as a potential comorbid condition. The hepatic and renal impairment were postulated to result from severe hypoxemia, and may also be modulated by neurohumoral mechanisms following massive cerebral infarction.<\/jats:p>","DOI":"10.3389\/fcvm.2026.1703463","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T06:34:07Z","timestamp":1771310047000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Neurogenic pulmonary edema coupled with myocardial damage following tenecteplase thrombolysis for acute ischemic stroke"],"prefix":"10.3389","volume":"13","author":[{"given":"Xiaowei","family":"Li","sequence":"first","affiliation":[{"name":"Department of Neurology, Xinle Hospital , Shijiazhuang","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haixia","family":"Mo","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xinle Hospital , Shijiazhuang","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huixin","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xinle Hospital , Shijiazhuang","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huijuan","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xinle Hospital , Shijiazhuang","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiannan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hebei Medical University Third Hospital , Shijiazhuang","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1710","DOI":"10.1097\/CCM.0000000000001101","article-title":"Neurogenic pulmonary edema","volume":"43","author":"Busl","year":"2015","journal-title":"Crit Care Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1159\/000500139","article-title":"Neurological perspectives of neurogenic pulmonary edema","volume":"81","author":"Finsterer","year":"2019","journal-title":"Eur Neurol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"110478","DOI":"10.1016\/j.biopha.2020.110478","article-title":"Neurogenic pulmonary edema following acute stroke: the progress and perspective","volume":"130","author":"Zhao","year":"2020","journal-title":"Biomed Pharmacother"},{"key":"B4","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1097\/00000539-200204000-00032","article-title":"Intrathecal lidocaine prevents cardiovascular collapse and neurogenic pulmonary edema in a rat model of acute intracranial hypertension","volume":"94","author":"Hall","year":"2002","journal-title":"Anesth Analg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1089\/neu.2014.3609","article-title":"Pathogenetic mechanisms of neurogenic pulmonary edema","volume":"32","author":"Sedy","year":"2015","journal-title":"J Neurotrauma"},{"key":"B6","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1016\/j.ajem.2020.11.052","article-title":"Neurogenic pulmonary edema","volume":"45","author":"Lo-Cao","year":"2021","journal-title":"Am J Emerg Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/S1474-4422(11)70291-5","article-title":"Cardiovascular and neurological causes of sudden death after ischaemic stroke","volume":"11","author":"S\u00f6r\u00f6s","year":"2012","journal-title":"The Lancet. Neurology"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2560","DOI":"10.1161\/STROKEAHA.108.536086","article-title":"Cardiac dysfunction after left permanent cerebral focal ischemia: the brain and heart connection","volume":"40","author":"Min","year":"2009","journal-title":"Stroke"},{"key":"B9","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1161\/CIRCRESAHA.117.311170","article-title":"Brain-heart interaction: cardiac complications after stroke","volume":"121","author":"Chen","year":"2017","journal-title":"Circ Res"},{"key":"B10","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1067\/mhj.2002.121264","article-title":"Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: a report from the Italian network on congestive heart failure","volume":"143","author":"Baldasseroni","year":"2002","journal-title":"Am Heart J"},{"key":"B11","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1177\/0284185119857433","article-title":"Imaging findings of pulmonary edema: part 1. Cardiogenic pulmonary edema and acute respiratory distress syndrome","volume":"61","author":"Tsuchiya","year":"2020","journal-title":"Acta Radiol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1590\/s1806-37132006000600008","article-title":"Hydrostatic pulmonary edema: high-resolution computed tomography aspects","volume":"32","author":"Ribeiro","year":"2006","journal-title":"J Bras Pneumol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1097\/MCC.0000000000000626","article-title":"Cardiogenic pulmonary edema: mechanisms and treatment - an intensivist\u2019s view","volume":"25","author":"Ingbar","year":"2019","journal-title":"Curr Opin Crit Care"},{"key":"B14","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1002\/ejhf.2115","article-title":"Universal definition and classification of heart failure: a report of the heart failure society of America, heart failure association of the European Society of Cardiology, Japanese heart failure society and writing committee of the universal definition of heart failure: endorsed by the Canadian heart failure society, heart failure association of India, cardiac society of Australia and New Zealand, and Chinese heart failure association","volume":"23","author":"Bozkurt","year":"2021","journal-title":"Eur J Heart Fail"},{"key":"B15","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.pcad.2024.01.017","article-title":"The spectrum of post-myocardial infarction care: from acute ischemia to heart failure","volume":"82","author":"Akhtar","year":"2024","journal-title":"Prog Cardiovasc Dis"},{"key":"B16","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1136\/heartjnl-2013-304289","article-title":"Infarct size reduction in acute myocardial infarction","volume":"101","author":"Mcalindon","year":"2015","journal-title":"Heart (British Cardiac Society)"},{"key":"B17","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1159\/000526250","article-title":"The development of pulmonary edema after recombinant tissue plasminogen activator in acute ischemic stroke patient; neurogenic or non-neurogenic?","volume":"14","author":"Alwahdy","year":"2022","journal-title":"Case Rep Neurol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1186\/s12883-021-02371-w","article-title":"Might life-threatening acute pulmonary edema occur after using recombinant tissue plasminogen activator? A case report","volume":"21","author":"Chen","year":"2021","journal-title":"BMC Neurol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"A77","DOI":"10.1161\/str.54.suppl_1.77","article-title":"Comparison of adverse reactions following intravenous alteplase versus intravenous tenecteplase for acute ischemic stroke in real world clinical practice","volume":"54","author":"Sara","year":"2023","journal-title":"Stroke"},{"key":"B20","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.ajem.2018.11.018","article-title":"Tenecteplase utility in acute ischemic stroke patients: a clinical review of current evidence","volume":"37","author":"Nelson","year":"2019","journal-title":"Am J Emerg Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.2165\/00003088-200241150-00001","article-title":"Pharmacokinetics and pharmacodynamics of tenecteplase in fibrinolytic therapy of acute myocardial infarction","volume":"41","author":"Tanswell","year":"2002","journal-title":"Clin Pharmacokinet"},{"key":"B22","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1016\/j.medcli.2020.04.023","article-title":"Takotsubo syndrome","volume":"155","author":"Aparisi","year":"2020","journal-title":"Med Clin (Barc)"},{"key":"B23","doi-asserted-by":"publisher","first-page":"49","DOI":"10.2176\/nmc.52.49","article-title":"Subarachnoid hemorrhage complicated with neurogenic pulmonary edema and takotsubo-like cardiomyopathy","volume":"52","author":"Inamasu","year":"2012","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"B24","doi-asserted-by":"publisher","first-page":"E73","DOI":"10.1093\/eurheartj\/suaa065","article-title":"Long-term injury after takotsubo syndrome (stress cardiomyopathy)","volume":"22","author":"Vassiliki\u2019 Coutsoumbas","year":"2020","journal-title":"Eur Heart J Suppl"},{"key":"B25","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.wneu.2021.01.139","article-title":"Takotsubo syndrome in neurologic disease","volume":"149","author":"Baker","year":"2021","journal-title":"World Neurosurg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1186\/s12882-018-1085-0","article-title":"Incidence and impact on outcomes of acute kidney injury after a stroke: a systematic review and meta-analysis","volume":"19","author":"Arnold","year":"2018","journal-title":"BMC Nephrol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s40635-020-00305-3","article-title":"Ischaemic stroke-induced distal organ damage: pathophysiology and new therapeutic strategies","volume":"8","author":"Robba","year":"2020","journal-title":"Intensive Care Med Exp"},{"key":"B28","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1055\/s-0032-1304813","article-title":"Effects of acute intracranial hypertension on extracerebral organs: a randomized experimental study in pigs","volume":"73","author":"Heuer","year":"2012","journal-title":"J Neurol Surg A Cent Eur Neurosurg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1097\/01.md.0000101573.54295.bd","article-title":"Hypoxic hepatitis: clinical and hemodynamic study in 142 consecutive cases","volume":"82","author":"Henrion","year":"2003","journal-title":"Medicine (Baltimore)"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1232","DOI":"10.4065\/81.9.1232","article-title":"Hypoxic liver injury","volume":"81","author":"Ebert","year":"2006","journal-title":"Mayo Clin Proc"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1703463\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T06:34:10Z","timestamp":1771310050000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1703463\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,17]]},"references-count":30,"alternative-id":["10.3389\/fcvm.2026.1703463"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1703463","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,17]]},"article-number":"1703463"}}